Provider Demographics
NPI:1033545900
Name:CHRISTENSEN, DALE BRIAN JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:BRIAN
Last Name:CHRISTENSEN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:DALE
Other - Middle Name:BRIAN
Other - Last Name:CHRISTENSEN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:942 WILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4945
Mailing Address - Country:US
Mailing Address - Phone:815-354-2881
Mailing Address - Fax:
Practice Address - Street 1:942 WILTSHIRE DRIVE
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-354-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist