Organization
DEGEN-BERGLUND, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL RECKASE (CHIEF EXECUTIVE OFFICER)
(608) 775-8500
Entity
Organization
Contact information
Practice address
2441 GREEN BAY ST, LA CROSSE, WI 54601
(608) 775-8571
(608) 775-8578
Mailing address
PO BOX 3157, LA CROSSE, WI 54602-3157
(608) 775-8500
(608) 775-8555
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
8773-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0516526
—
IA
05
—
33236300
—
WI
01
—
5106489
NCPDP
WI
Enumeration date
06/28/2006
Last updated
03/07/2023
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