Provider Demographics
NPI:1659809374
Name:WALBERG, BRETTON CLARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRETTON
Middle Name:CLARK
Last Name:WALBERG
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 1:260 DONATION RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-8008
Mailing Address - Country:US
Mailing Address - Phone:724-612-2131
Mailing Address - Fax:
Practice Address - Street 1:260 DONATION RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-8008
Practice Address - Country:US
Practice Address - Phone:724-612-2131
Practice Address - Fax:724-588-2047
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044321L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist