Basic Information
| Provider Information | |||||||||
| NPI: | 1023622982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALAMBECK | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 PINE RIDGE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544014122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472547 | ||||||||
| FaxNumber: | 7158472551 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 PINE RIDGE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544014122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472547 | ||||||||
| FaxNumber: | 7158472551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 12565 | WI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.