Provider Demographics
NPI:1477837839
Name:BERNDT, NATHANIEL W (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:W
Last Name:BERNDT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-1815
Mailing Address - Country:US
Mailing Address - Phone:608-779-0939
Mailing Address - Fax:608-783-0061
Practice Address - Street 1:4415 STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-1815
Practice Address - Country:US
Practice Address - Phone:608-779-0939
Practice Address - Fax:608-783-0061
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14892-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist