MEDICARE: MR. PHILIP L BERGER BPHARM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH46908	CA

General Provider Information

NPI Number	:	1053701540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP L BERGER BPHARM

Provider Business Mailing Address
First Line	:	PO BOX 940896
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93094-0896
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30495 CANWOOD ST
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4331
Country	:	US
Telephone Number	:	818-532-7150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	11/15/2016

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