Healthcare Provider Details

I. General information

NPI: 1336001551
Provider Name (Legal Business Name): JANELLE MICHELLE IWEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 CARDINAL LN
GREEN BAY WI
54313-9569
US

IV. Provider business mailing address

2727 NEWBERRY AVE
GREEN BAY WI
54302-5111
US

V. Phone/Fax

Practice location:
  • Phone: 920-661-9355
  • Fax: 920-661-9309
Mailing address:
  • Phone: 920-661-9355
  • Fax: 920-661-9309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23292-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: