Provider Demographics
NPI:1548435886
Name:BOYSEN, JOHN PETER (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:BOYSEN
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 1:340 SOUTH 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6012
Mailing Address - Country:US
Mailing Address - Phone:608-784-8556
Mailing Address - Fax:
Practice Address - Street 1:2441 GREEN BAY ST
Practice Address - Street 2:IV PHARMACY
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-775-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117393183500000X
WI9742040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist