Basic Information
| Provider Information | |||||||||
| NPI: | 1083602809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASELOW | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 442 | ||||||||
| Address2: | |||||||||
| City: | BEAVER BAY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 556010442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182264905 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 211 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558062719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187261370 | ||||||||
| FaxNumber: | 2187260501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 116852-7 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.