Provider Demographics
NPI:1265031405
Name:FUSSELMAN, CARMEN A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:A
Last Name:FUSSELMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W127N10858 CONEFLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4464
Mailing Address - Country:US
Mailing Address - Phone:262-239-9268
Mailing Address - Fax:414-231-5308
Practice Address - Street 1:N112W16200 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3334
Practice Address - Country:US
Practice Address - Phone:262-253-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4825054-17011835P0018X
IA179371835P0018X
NE102691835P0018X
WI15403-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist