Provider Demographics
NPI:1760437149
Name:SVENVOLD, GWENDOLYN F (PHARM D)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:F
Last Name:SVENVOLD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 WAYZATA BLVD E
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1935
Mailing Address - Country:US
Mailing Address - Phone:952-473-1687
Mailing Address - Fax:952-473-0782
Practice Address - Street 1:1151 WAYZATA BLVD E
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1935
Practice Address - Country:US
Practice Address - Phone:952-473-1687
Practice Address - Fax:952-473-0782
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116590-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6758226OtherSTATE TAX ID NO.
MN2426167OtherNCPDP NO.
MN2426167OtherNCPDP NO.