Provider Demographics
NPI:1710173141
Name:KALLIO, RICHARD J (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:KALLIO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 N WASHINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2984
Mailing Address - Country:US
Mailing Address - Phone:608-755-3599
Mailing Address - Fax:608-755-3553
Practice Address - Street 1:580 N WASHINGTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2984
Practice Address - Country:US
Practice Address - Phone:608-755-3599
Practice Address - Fax:608-755-3553
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9120-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist