Healthcare Provider Details

I. General information

NPI: 1891613360
Provider Name (Legal Business Name): SUSAN RENEE VANDENBERG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 STATE HIGHWAY 270
HILLS MN
56138-4051
US

IV. Provider business mailing address

631 STATE HIGHWAY 270
HILLS MN
56138-4051
US

V. Phone/Fax

Practice location:
  • Phone: 605-359-6066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR-5499
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: