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General NPI Number Information
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NPI Number | 1760053789
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Entity Type | Individual
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Provider Name | BRIELLE ANN VAN DEN BERG PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 12850 L ST
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City | OMAHA
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State | NE
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Zip | 68137-2078
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Country | US
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Telephone | 402-697-1742
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Fax |
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Provider Business Mailing Address
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Address Line | 2823 N 110TH CT APT 104
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City | OMAHA
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State | NE
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Zip | 68164-1222
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Country | US
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Telephone | 402-366-3768
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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 | 17146
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License Number State | NE
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