Provider Demographics
NPI:1235624925
Name:FAHEY, OLIVIA GWEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:GWEN
Last Name:FAHEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HIGHLAND AVENUE
Mailing Address - Street 2:F6/133
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVENUE
Practice Address - Street 2:F6/133
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792
Practice Address - Country:US
Practice Address - Phone:608-263-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19328-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist