Healthcare Provider Details

I. General information

NPI: 1245246891
Provider Name (Legal Business Name): T A SOLBERG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E WALL ST
EAGLE RIVER WI
54521-8720
US

IV. Provider business mailing address

PO BOX 50
MINOCQUA WI
54548-0050
US

V. Phone/Fax

Practice location:
  • Phone: 715-479-6413
  • Fax: 715-479-4621
Mailing address:
  • Phone: 715-356-7711
  • Fax: 715-356-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8061
License Number StateWI

VIII. Authorized Official

Name: TRYGVE SOLBERG
Title or Position: CEO
Credential:
Phone: 715-356-7711