=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437203254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERGMANNS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2960 CAHILL MAIN # 2
-----------------------------------------------------
City | FITCHBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53711-7157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-273-4490
-----------------------------------------------------
Fax | 608-273-8583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2960 CAHILL MAIN # 2
-----------------------------------------------------
City | FITCHBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53711-7157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-273-4490
-----------------------------------------------------
Fax | 608-273-8583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | DARREL L BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-273-4490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8223
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------