Healthcare Provider Details

I. General information

NPI: 1902175177
Provider Name (Legal Business Name): MICHAEL CHRISTIAN BERGER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2011
Last Update Date: 12/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3593 CLEVELAND AVE
FORT MYERS FL
33901-7975
US

IV. Provider business mailing address

3593 CLEVELAND AVE
FORT MYERS FL
33901-7975
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-4741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS41371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: