Provider Demographics
NPI:1912195116
Name:HALWEG, SUSAN L
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:HALWEG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JOHN Q HAMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1959
Mailing Address - Country:US
Mailing Address - Phone:608-410-2706
Mailing Address - Fax:608-410-2903
Practice Address - Street 1:1200 JOHN Q HAMMONS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1959
Practice Address - Country:US
Practice Address - Phone:608-410-2706
Practice Address - Fax:608-410-2903
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist