Provider Demographics
NPI:1649576364
Name:WADE J DAHLBERG SR
Entity Type:Organization
Organization Name:WADE J DAHLBERG SR
Other - Org Name:WEST COAST PHARMACEUTICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATION MGT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-373-9215
Mailing Address - Street 1:2697 LAVERY CT STE 7
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1587
Mailing Address - Country:US
Mailing Address - Phone:805-499-0100
Mailing Address - Fax:805-499-0199
Practice Address - Street 1:2697 LAVERY CT STE 7
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1587
Practice Address - Country:US
Practice Address - Phone:805-499-0100
Practice Address - Fax:805-499-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X
CAPHY503933336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5640087OtherNCPDP PROVIDER IDENTIFICATION NUMBER