=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548786122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERKS PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2017
-----------------------------------------------------
Last Update Date | 02/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 PENN ST STE B
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19602-1085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-373-1800
-----------------------------------------------------
Fax | 610-373-1818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 PENN ST STE B
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19602-1085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-373-1800
-----------------------------------------------------
Fax | 610-373-1818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | PUSHPALU PALADUGU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-373-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP482444
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------