Healthcare Provider Details

I. General information

NPI: 1902582380
Provider Name (Legal Business Name): SABRINA BERGERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 MCCRACKEN RD STE A
GARFIELD HEIGHTS OH
44125-2946
US

IV. Provider business mailing address

1681 LEE RD
CLEVELAND HEIGHTS OH
44118-1722
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number10013612
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: