Healthcare Provider Details

I. General information

NPI: 1437235314
Provider Name (Legal Business Name): SCOTT BERGMAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST # 19636 SIU INFECTIOUS DISEASES
SPRINGFIELD IL
62702-3757
US

IV. Provider business mailing address

1804 PROVIDENCE LN
SPRINGFIELD IL
62711
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-4040
  • Fax: 217-545-8025
Mailing address:
  • Phone: 217-726-5977
  • Fax: 217-726-5977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: