Healthcare Provider Details

I. General information

NPI: 1508760117
Provider Name (Legal Business Name): CARLA L VAN DEN BERG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

702 E PIKES PEAK AVE APT 133
COLORADO SPRINGS CO
80903-3699
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5000
  • Fax:
Mailing address:
  • Phone: 512-968-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number0015161
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: