Provider Demographics
NPI:1154570596
Name:HAASE, JOAN P (RPH)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:P
Last Name:HAASE
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 1:4830 HIGHWAY 9 N
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2975
Mailing Address - Country:US
Mailing Address - Phone:770-777-0589
Mailing Address - Fax:770-777-0768
Practice Address - Street 1:4692 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6150
Practice Address - Country:US
Practice Address - Phone:770-489-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist