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General NPI Number Information
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NPI Number | 1457366007
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Entity Type | Organization
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Legal Business Name | NYBERG HEALTH ENTERPRISES INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 7730 CENTER BLVD SE
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City | SNOQUALMIE
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State | WA
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Zip | 98065-8743
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Country | US
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Telephone | 425-396-7474
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Fax | 425-396-7454
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Provider Business Mailing Address
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Address Line | PO BOX 797
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City | SNOQUALMIE
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State | WA
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Zip | 98065-0797
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Country | US
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Telephone | 425-396-7474
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Fax | 425-396-7454
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Authorized Official
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Title or Position | PRES AND VP
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Name | BROCKMAN/SHANNA NYBERG
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Credential | BS PHARM
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Telephone | 425-221-0129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHARCF00058496
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License Number State | WA
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