Provider Demographics
NPI:1255416707
Name:HAGGERTY, AMY A (PHARM D)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 S CHESAPEAKE CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4552
Mailing Address - Country:US
Mailing Address - Phone:605-361-6206
Mailing Address - Fax:
Practice Address - Street 1:4901 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0444
Practice Address - Country:US
Practice Address - Phone:605-373-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5179OtherSTATE PHARMACIST LICENSE