Provider Demographics
NPI:1457828998
Name:OWEN, CHRISTIAN (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:OWEN
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 1:505 GOPHER DR STE A
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-4513
Mailing Address - Country:US
Mailing Address - Phone:608-567-2811
Mailing Address - Fax:608-567-2814
Practice Address - Street 1:505 GOPHER DR STE A
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-4513
Practice Address - Country:US
Practice Address - Phone:608-567-2811
Practice Address - Fax:608-567-2814
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12943-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist