Healthcare Provider Details

I. General information

NPI: 1629208632
Provider Name (Legal Business Name): DEGEN-BERGLUND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 CROSSING MEADOWS DR
ONALASKA WI
54650-8666
US

IV. Provider business mailing address

PO BOX 3157
LA CROSSE WI
54602-3157
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8865
  • Fax:
Mailing address:
  • Phone: 608-775-8500
  • Fax: 608-775-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8937-042
License Number StateWI

VIII. Authorized Official

Name: MR. DANIEL RECKASE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 608-775-8500