Provider Demographics
NPI:1023622982
Name:HALAMBECK, LYNN MARIE (RPH)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:HALAMBECK
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 1:425 PINE RIDGE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4122
Mailing Address - Country:US
Mailing Address - Phone:715-847-2547
Mailing Address - Fax:715-847-2551
Practice Address - Street 1:425 PINE RIDGE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4122
Practice Address - Country:US
Practice Address - Phone:715-847-2547
Practice Address - Fax:715-847-2551
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist