Provider Demographics
NPI:1922604008
Name:HASELBERGER, SANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HASELBERGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-4500
Mailing Address - Country:US
Mailing Address - Phone:651-982-4603
Mailing Address - Fax:651-982-4626
Practice Address - Street 1:2013 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-4500
Practice Address - Country:US
Practice Address - Phone:651-982-4603
Practice Address - Fax:651-982-4626
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist