Healthcare Provider Details

I. General information

NPI: 1265490007
Provider Name (Legal Business Name): BERGS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 3RD ST S
WATERVILLE MN
56096-1444
US

IV. Provider business mailing address

103 3RD ST S
WATERVILLE MN
56096-1444
US

V. Phone/Fax

Practice location:
  • Phone: 507-362-8500
  • Fax: 507-362-8090
Mailing address:
  • Phone: 507-362-8500
  • Fax: 507-362-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number260828
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH COOK
Title or Position: PRESIDENT
Credential:
Phone: 507-362-8500