Provider Demographics
NPI:1215928718
Name:ZOBERG, BRIAN M (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:M
Last Name:ZOBERG
Suffix:
Gender:M
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:P.O BOX 4268525
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:305-301-2443
Mailing Address - Fax:350-675-5733
Practice Address - Street 1:3610 SAN SIMEON CIR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-5043
Practice Address - Country:US
Practice Address - Phone:305-301-2443
Practice Address - Fax:305-675-5733
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34023183500000X
FLPU59591835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist