Provider Demographics
NPI:1093891046
Name:CHRISTENSEN, DEAN M (RPH)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:M
Last Name:CHRISTENSEN
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 1:1430 APRICOT ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-3045
Mailing Address - Country:US
Mailing Address - Phone:715-423-9751
Mailing Address - Fax:715-258-1674
Practice Address - Street 1:N2665 COUNTY RD QQ
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:WI
Practice Address - Zip Code:54946-0600
Practice Address - Country:US
Practice Address - Phone:715-258-1674
Practice Address - Fax:715-258-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10615 040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist