Provider Demographics
NPI:1588159065
Name:HALBACH, BROOKE ERIN (RPH)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ERIN
Last Name:HALBACH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ERIN
Other - Last Name:GEIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1446
Mailing Address - Country:US
Mailing Address - Phone:920-378-7031
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792
Practice Address - Country:US
Practice Address - Phone:608-378-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19261-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist