Provider Demographics
NPI:1578852646
Name:WINTERBERG, BRIAN DALE (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DALE
Last Name:WINTERBERG
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542-0052
Mailing Address - Country:US
Mailing Address - Phone:707-923-2628
Mailing Address - Fax:
Practice Address - Street 1:875 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3106
Practice Address - Country:US
Practice Address - Phone:707-923-2461
Practice Address - Fax:707-923-4038
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist