Provider Demographics
NPI:1629208632
Name:DEGEN-BERGLUND INC
Entity Type:Organization
Organization Name:DEGEN-BERGLUND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-775-8500
Mailing Address - Street 1:PO BOX 3157
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54602-3157
Mailing Address - Country:US
Mailing Address - Phone:608-775-8500
Mailing Address - Fax:608-775-8555
Practice Address - Street 1:1260 CROSSING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8666
Practice Address - Country:US
Practice Address - Phone:608-775-8865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8937-0423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy