Provider Demographics
NPI:1760533137
Name:OBERG, HARRY WILLIAM CONRAD III (RPH)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:WILLIAM CONRAD
Last Name:OBERG
Suffix:III
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 1:13643 STATE HIGHWAY 150 S
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9752
Mailing Address - Country:US
Mailing Address - Phone:307-789-9876
Mailing Address - Fax:307-789-9876
Practice Address - Street 1:524 FRONT ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3577
Practice Address - Country:US
Practice Address - Phone:307-789-3494
Practice Address - Fax:307-789-5554
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY2074OtherPHARMACIST CERTIFICATE NO