Healthcare Provider Details

I. General information

NPI: 1154790475
Provider Name (Legal Business Name): AARON VAN DEN BERG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 10TH ST
ROCK VALLEY IA
51247-1532
US

IV. Provider business mailing address

PO BOX 154
ROCK VALLEY IA
51247-0154
US

V. Phone/Fax

Practice location:
  • Phone: 712-476-5171
  • Fax: 712-476-2254
Mailing address:
  • Phone: 712-476-5171
  • Fax: 712-476-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21761
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: