Ellen Marie Bergendahl
Individual provider Active NPI Pharmacist · Baraboo, WI
NPI 1457733669 · NPPES record last updated Nov 15, 2024
Key facts
- NPI
- 1457733669
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 17922-40 (WI)
- Practice address
- 1700 Tuttle St
Baraboo, WI 53913-3319 - Phone
- (608) 355-3800
- NPI assigned
- Jun 24, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17922-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17922-40 | WI | Yes |
Addresses
Primary practice location
1700 Tuttle St
Baraboo, WI 53913-3319
Mailing address
1700 Tuttle St
Baraboo, WI 53913-3319
Other names
- Ellen Marie Schwartz
Other providers in Baraboo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.