Provider Demographics
NPI:1154643005
Name:HABLE, DANIEL WILLIAM (RPH)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:HABLE
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 1:18675 IBSEN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-3761
Mailing Address - Country:US
Mailing Address - Phone:608-269-1199
Mailing Address - Fax:608-372-7185
Practice Address - Street 1:300 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-1636
Practice Address - Country:US
Practice Address - Phone:608-372-2101
Practice Address - Fax:608-372-7185
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13706-40333600000X
WI13706-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5100970OtherNABP
WI33123400Medicaid