Provider Demographics
NPI:1851506539
Name:AMEDEN, DENNIS THEODORE (RPH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:THEODORE
Last Name:AMEDEN
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 1:725 S 95TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2721
Mailing Address - Country:US
Mailing Address - Phone:414-476-0409
Mailing Address - Fax:
Practice Address - Street 1:725 S 95TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2721
Practice Address - Country:US
Practice Address - Phone:414-476-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8017-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist