MEDICARE: MR. ANTHONY GERARD BERRA R.PH.

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
1	183500000X	Pharmacist	051-036093	IL
2	183500000X	Pharmacist	041710	MO

General Provider Information

NPI Number	:	1740239631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY GERARD BERRA R.PH.

Provider Business Mailing Address
First Line	:	522 BAMBURY WAY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-1143
Country	:	US
Telephone Number	:	314-966-4519
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 FOREST PARK AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2114
Country	:	US
Telephone Number	:	314-657-9013
Fax Number	:	314-747-4579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	05/14/2025

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