Provider Demographics
NPI:1043228356
Name:T A SOLBERG CO INC
Entity Type:Organization
Organization Name:T A SOLBERG CO INC
Other - Org Name:TRIGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRYGVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-356-7711
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-0050
Mailing Address - Country:US
Mailing Address - Phone:715-356-7711
Mailing Address - Fax:715-356-7871
Practice Address - Street 1:9750 STATE HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9753
Practice Address - Country:US
Practice Address - Phone:715-356-9449
Practice Address - Fax:715-356-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI66483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114524OtherPK
WI33055400Medicaid
WI33055400Medicaid