MEDICARE: GALEN W. GOERTZEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00016588	WA

General Provider Information

NPI Number	:	1902944242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALEN W. GOERTZEN

Provider Business Mailing Address
First Line	:	PO BOX 34584
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1584
Country	:	US
Telephone Number	:	509-241-7349
Fax Number	:	509-241-7628

Provider Business Practice Location Address
First Line	:	5615 W SUNSET HWY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-9454
Country	:	US
Telephone Number	:	509-241-7572
Fax Number	:	509-434-3118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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Directions to “ GALEN W. GOERTZEN ” Practice Location

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