Provider Demographics
NPI:1891772828
Name:BJERKE, PETER F (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:F
Last Name:BJERKE
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 1:26115 CLUB LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CABLE
Mailing Address - State:WI
Mailing Address - Zip Code:54821-4967
Mailing Address - Country:US
Mailing Address - Phone:507-269-9191
Mailing Address - Fax:
Practice Address - Street 1:26115 CLUB LAKE RD
Practice Address - Street 2:
Practice Address - City:CABLE
Practice Address - State:WI
Practice Address - Zip Code:54821-4967
Practice Address - Country:US
Practice Address - Phone:715-794-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115327-3183500000X
WI8328-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist