Provider Demographics
NPI:1447962899
Name:BERG-CROOKS, TERESA VIVIAN (RPH)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:VIVIAN
Last Name:BERG-CROOKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11386 33K ST SE
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-9447
Mailing Address - Country:US
Mailing Address - Phone:701-840-8028
Mailing Address - Fax:
Practice Address - Street 1:323 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-2915
Practice Address - Country:US
Practice Address - Phone:701-845-5280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH4329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist