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NPI Code Detail

MEDICARE: KAREN MARIE BERGSTROM RPH

MEDICARE: KAREN MARIE BERGSTROM RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist14792CO

General Provider Information

NPI Number : 1093092314
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN MARIE BERGSTROM RPH
Provider Business Mailing Address
First Line : 280 MAIN ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80911-1712
Country : US
Telephone Number : 719-390-9123
Fax Number : 719-392-5149
Provider Business Practice Location Address
First Line : 280 MAIN ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80911-1712
Country : US
Telephone Number : 719-390-9123
Fax Number : 719-390-5149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2011
Last Update Date : 11/15/2011

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Directions to “ KAREN MARIE BERGSTROM RPH” Practice Location

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