Provider Demographics
NPI:1669043725
Name:FALK, ALEXANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:FALK
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 1:1134 DELEGLISE ST
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-1517
Mailing Address - Country:US
Mailing Address - Phone:715-219-1565
Mailing Address - Fax:
Practice Address - Street 1:536 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2221
Practice Address - Country:US
Practice Address - Phone:715-623-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist