Basic Information
| Provider Information | |||||||||
| NPI: | 1720345473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANNA | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | S2845 WHITE EAGLE RD | ||||||||
| Address2: | |||||||||
| City: | BARABOO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539139064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083555177 | ||||||||
| FaxNumber: | 6083561233 | ||||||||
| Practice Location | |||||||||
| Address1: | S2845 WHITE EAGLE RD | ||||||||
| Address2: | |||||||||
| City: | BARABOO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539139064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083555177 | ||||||||
| FaxNumber: | 6083561233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2012 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 16065-040 | WI | N | Pharmacy Service Providers | Pharmacist | 1835P1200X | 16065-040 | WI | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1300X | 16065-040 | WI | N | Pharmacy Service Providers | Pharmacist | Psychiatric | 1835P0018X | 16065-040 | WI | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.