Healthcare Provider Details

I. General information

NPI: 1245677079
Provider Name (Legal Business Name): MADELINE BERGIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TROWBRIDGE RD
BOURNE MA
02532-3660
US

IV. Provider business mailing address

1 TROWBRIDGE RD
BOURNE MA
02532-3660
US

V. Phone/Fax

Practice location:
  • Phone: 508-743-9563
  • Fax: 508-743-0206
Mailing address:
  • Phone: 508-743-9563
  • Fax: 508-743-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18038
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: