Provider Demographics
NPI:1578849709
Name:SALBERG, KENNETH LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LEE
Last Name:SALBERG
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 1:1611 COUNTY ROAD C W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1302
Mailing Address - Country:US
Mailing Address - Phone:651-636-9369
Mailing Address - Fax:
Practice Address - Street 1:1611 W COUNTY ROAD C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1302
Practice Address - Country:US
Practice Address - Phone:651-636-9369
Practice Address - Fax:651-636-4015
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist