Provider Demographics
NPI:1720352578
Name:SWENSON, GALEN STANLEY (RPH)
Entity Type:Individual
Prefix:MR
First Name:GALEN
Middle Name:STANLEY
Last Name:SWENSON
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 1:5143 N SHORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5542
Mailing Address - Country:US
Mailing Address - Phone:414-962-4522
Mailing Address - Fax:414-463-0620
Practice Address - Street 1:5143 N SHORELAND AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5542
Practice Address - Country:US
Practice Address - Phone:414-962-4522
Practice Address - Fax:414-463-0620
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72659-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist