MEDICARE: MICHAEL BERNS PHARMD

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	26024695A	IN
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	26024695A	IN

General Provider Information

NPI Number	:	1174913271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BERNS PHARMD

Provider Business Mailing Address
First Line	:	4076 NEELY RD
Second Line	:
City	:	FT WAINWRIGHT
State	:	AK
Zip	:	99703-5002
Country	:	US
Telephone Number	:	907-361-2317
Fax Number	:	907-361-4838

Provider Business Practice Location Address
First Line	:	1060 GAFFNEY RD
Second Line	:	#7400
City	:	FT WAINWRIGHT
State	:	AK
Zip	:	99703-5002
Country	:	US
Telephone Number	:	907-361-2317
Fax Number	:	907-361-4838

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

Provider Enumeration Date	:	01/27/2015
Last Update Date	:	06/27/2016

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