Provider Demographics
NPI:1336269539
Name:SABIN-HAGGERTY, RENEE GABRIELLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:GABRIELLE
Last Name:SABIN-HAGGERTY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:GABRIELLE
Other - Last Name:SABIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:42 WESTBROOK PL
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4418
Mailing Address - Country:US
Mailing Address - Phone:716-830-3482
Mailing Address - Fax:
Practice Address - Street 1:3852 MAIN ST
Practice Address - Street 2:RITE AID STORE #10704
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484
Practice Address - Country:US
Practice Address - Phone:845-687-7766
Practice Address - Fax:845-687-0570
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist