Provider Demographics
NPI:1841238953
Name:OIEN, GARY M (RPH,)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:OIEN
Suffix:
Gender:M
Credentials:RPH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4780 BUTTERFIELD CT NE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1284
Mailing Address - Country:US
Mailing Address - Phone:612-866-8362
Mailing Address - Fax:612-866-1227
Practice Address - Street 1:6228 PENN AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-1135
Practice Address - Country:US
Practice Address - Phone:612-866-8362
Practice Address - Fax:612-866-1227
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1137367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist