MEDICARE: MRS. KAITLYN BERGERON PHARM.D

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	023482	LA

General Provider Information

NPI Number	:	1144830373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAITLYN BERGERON PHARM.D

Provider Business Mailing Address
First Line	:	1111 MEDICAL CENTER BLVD STE N116
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3152
Country	:	US
Telephone Number	:	504-349-6185
Fax Number	:	504-349-6188

Provider Business Practice Location Address
First Line	:	1111 MEDICAL CENTER BLVD STE N116
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3152
Country	:	US
Telephone Number	:	504-349-6185
Fax Number	:	504-349-6188

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	10/02/2024

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