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General NPI Number Information
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NPI Number | 1962656108
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Entity Type | Individual
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Provider Name | SCOTT RODERICK BERGERON PHARMD., RPH
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Gender | Male
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 9159 SE 82ND AVE
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-3761
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Country | US
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Telephone | 503-771-1386
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 W TRINITY MILLS RD
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City | CARROLLTON
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State | TX
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Zip | 75006-1375
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Country | US
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Telephone | 800-273-3455
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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 | 52736
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 41574
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60091125
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0010850
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License Number State | OR
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