Berg, Thomas Richard

Berg, Thomas Richard is an sole proprietor health care provider with primary practice located at 39 Shortcut Road , Inchelium WA 99138-0290. He recently has 2 registered licenses in different health care specialties including Pharmacy Service Providers / Pharmacist, Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy. Pharmacy Service Providers / Pharmacist is his primary health care specialty. Berg, Thomas Richard can be contacted via phone (509) 722-7009.

Contact Information

Primary practice address
39 Shortcut Road Inchelium WA 99138-0290
Phone: (509) 722-7009
Fax: (509) 722-7021
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 4214 South Dakota
Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X CF00003827 Washington

Profile Details

NPI number 1255485355
LBN Legal business name Berg, Thomas Richard
Credentials R.PH.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 23rd, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255485355 NPPES
Washington Other 4924735 NABP
Washington Other CF00003827 NABP
Washington MEDICAID 6008767 NABP

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