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General NPI Number Information
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NPI Number | 1114575461
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Entity Type | Individual
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Provider Name | LEAH BERGER RPH
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Gender | Female
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 240 NW LOST SPRINGS TER STE 36
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City | PORTLAND
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State | OR
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Zip | 97229-6571
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Country | US
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Telephone | 503-596-3566
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Fax |
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Provider Business Mailing Address
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Address Line | 7170 W CRYSTAL RD
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City | GLENDALE
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State | AZ
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Zip | 85308-9574
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Country | US
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Telephone | 623-308-2879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0017412
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License Number State | OR
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