Provider Demographics
NPI:1235449042
Name:SANDBERG, DAVID BRUCE (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 16TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6778
Mailing Address - Country:US
Mailing Address - Phone:701-833-6222
Mailing Address - Fax:
Practice Address - Street 1:20 26TH ST E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3046
Practice Address - Country:US
Practice Address - Phone:701-572-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist