Provider Demographics
NPI:1891033247
Name:ZANDBERG, DAVID C (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:ZANDBERG
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 1:138 W ELLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1408
Mailing Address - Country:US
Mailing Address - Phone:503-831-6006
Mailing Address - Fax:503-831-6008
Practice Address - Street 1:138 W ELLENDALE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1408
Practice Address - Country:US
Practice Address - Phone:503-831-6006
Practice Address - Fax:503-831-6008
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17050183500000X
UT6080043-1701183500000X
NJ17476183500000X
WAPH00067430183500000X
AZS015790183500000X
ORRPH-0010856183500000X
CA44705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist