Melissa Haakenson
Individual provider Active NPI Pharmacist · Wales, WI
NPI 1245515006 · NPPES record last updated Oct 12, 2011
Key facts
- NPI
- 1245515006
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 14423 (WI)
- Practice address
- 320 W Summit Ave
Wales, WI 53183-9436 - Phone
- (262) 968-6900
- NPI assigned
- Oct 12, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14423 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 14423 | WI | Yes |
Addresses
Primary practice location
320 W Summit Ave
Wales, WI 53183-9436
Mailing address
W358N6678 W Spring Hollow Cir
Oconomowoc, WI 53066-6211
Other providers in Wales, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.