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General NPI Number Information
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NPI Number | 1023454030
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Entity Type | Individual
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Provider Name | FALLON PALMA HAGEN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 21 S JACKSON ST SUITE 100
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City | JANESVILLE
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State | WI
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Zip | 53548
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Country | US
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Telephone | 608-752-7869
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Fax | 608-752-6806
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Provider Business Mailing Address
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Address Line | 1109 TERAPIN TRL
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City | JANESVILLE
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State | WI
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Zip | 53545-7811
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Country | US
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Telephone | 608-931-0932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15918-40
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License Number State | WI
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