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General NPI Number Information
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NPI Number | 1235449042
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Entity Type | Individual
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Provider Name | DAVID BRUCE SANDBERG RPH
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Gender | Male
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 20 26TH ST E
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City | WILLISTON
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State | ND
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Zip | 58801-3046
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Country | US
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Telephone | 701-572-9168
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Fax |
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Provider Business Mailing Address
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Address Line | 917 16TH AVE SE
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City | MINOT
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State | ND
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Zip | 58701-6778
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Country | US
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Telephone | 701-833-6222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3298
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License Number State | ND
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