| Doctor Name: | MR. JOSEPH JOHN BERGSTAD |
| NPI Number: | 1174864508 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CPHT |
| License Number: | 716705 |
| Business Practice Address: | 7560 160th St W Lakeville, MN - 550448348 |
| Business Phone Number: | 9528911167 |
| Business Fax Number: | 9528913337 |
| Mailing Address: | 7560 160th St W, LAKEVILLE |
| State: | MN |
| Postal Code: | 550448348 |
| Phone Number: | 9528911167 |
| Fax Number: | 9528913337 |
| NPI Enumeration Date: | 03/11/2013 |
| NPI Last Update Date: | 03/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 183700000X |
| License Number: | 716705 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacy Technician |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |