Provider Demographics
NPI:1770917304
Name:LA HAIE, MARY (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:LA HAIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5776 GOLDFINCH LN
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-8430
Mailing Address - Country:US
Mailing Address - Phone:715-453-4450
Mailing Address - Fax:
Practice Address - Street 1:W5776 GOLDFINCH LN
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-8430
Practice Address - Country:US
Practice Address - Phone:715-453-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9261-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist