Paul Soderberg, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

15393 Issued in CO

Practice address

Pob 1302
101 Martin Way
Kremmling, CO 80459-1302

Phone

(970) 724-3205

Fax

(970) 724-3225

NPI assigned

Aug 30, 2012

Last updated

Aug 30, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kremmling Mercantile LLC

  dba Kremmling Mercantile

  • Community/Retail Pharmacy
  • Kremmling, CO
  • NPI 1376608562
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1487903811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1302",
            "address_2": "308 10TH ST N.",
            "city": "KREMMLING",
            "state": "CO",
            "postal_code": "804591302",
            "telephone_number": "970-724-3205",
            "fax_number": "970-724-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "POB 1302",
            "address_2": "101 MARTIN WAY",
            "city": "KREMMLING",
            "state": "CO",
            "postal_code": "804591302",
            "telephone_number": "970-724-3205",
            "fax_number": "970-724-3225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERBERG",
        "first_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-30",
        "last_updated": "2012-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "15393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF PHARMACY-PHARMACIST LICENSE",
            "identifier": "15393",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca R Pearson, CCC-SLP
• Robert Craig Ratcliff, M.D.
• William Rose, MD
• Rachel Halloran Scott, FNP
• Halee See
• Lyndsey Nykiel Stuerman, ANP
• Jodi Desiree' Sturgeon, MD
• Lynnette C Telck, M.D.
• Frank Shane Tong Jr., D.O.
• Christina Ann Travis, F.N.P.

• Pharmacist in Kremmling, CO
• Providers in Kremmling, CO by specialty
• Pharmacist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.