Provider Demographics
NPI:1598895757
Name:AHLGRIMM, MARLA (RPH)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:AHLGRIMM
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 1:5832 OSMUNDSEN CT
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5146
Mailing Address - Country:US
Mailing Address - Phone:608-276-7702
Mailing Address - Fax:
Practice Address - Street 1:1289 DEMING WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2007
Practice Address - Country:US
Practice Address - Phone:608-833-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9521-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist