Provider Demographics
NPI:1588964498
Name:JURGENS, DENNIS ANTHONY (RPH)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ANTHONY
Last Name:JURGENS
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 1:510 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5425
Mailing Address - Country:US
Mailing Address - Phone:509-884-2800
Mailing Address - Fax:509-886-2066
Practice Address - Street 1:510 GRANT RD
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5425
Practice Address - Country:US
Practice Address - Phone:509-884-2800
Practice Address - Fax:509-886-2066
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00009537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist