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General NPI Number Information
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NPI Number | 1821373986
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Entity Type | Individual
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Provider Name | JAMES OSCAR LABERGE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 2015 TOWER AVE
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City | SUPERIOR
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State | WI
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Zip | 54880-2538
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Country | US
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Telephone | 715-392-9550
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Fax |
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Provider Business Mailing Address
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Address Line | 913 GRANDVIEW AVE
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City | DULUTH
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State | MN
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Zip | 55812-1147
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Country | US
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Telephone | 218-721-2113
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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 | 16179-040
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 120185
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License Number State | MN
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