Healthcare Provider Details

I. General information

NPI: 1184843047
Provider Name (Legal Business Name): CHRISTOPHER BYRON FORBERG BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY SUITE 250
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

5315 S GREENTREE DR
NEW BERLIN WI
53151-8194
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-7810
  • Fax:
Mailing address:
  • Phone: 414-427-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11509
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: