Healthcare Provider Details

I. General information

NPI: 1831434307
Provider Name (Legal Business Name): BARBARA JEANNE HAGENBROCK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W ADAMS ST
BLACK RIVER FALLS WI
54615
US

IV. Provider business mailing address

PO BOX 156 610 W ADAMS ST
BLACK RIVER FALLS WI
54615
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-4089
  • Fax: 715-284-1606
Mailing address:
  • Phone: 715-284-4059
  • Fax: 715-284-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10885
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: