MEDICARE: MR. JEFFERY ARTHUR BERK RPH

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	1835P1200X	Pharmacotherapy Pharmacist	12238	IN

General Provider Information

NPI Number	:	1437204336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFERY ARTHUR BERK RPH

Provider Business Mailing Address
First Line	:	1829 REDWOOD CT
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-1096
Country	:	US
Telephone Number	:	219-322-0641
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 W 84TH DR
Second Line	:
City	:	MERRILLVILLE BRA
State	:	IN
Zip	:	46410-6243
Country	:	US
Telephone Number	:	219-756-4340
Fax Number	:	219-756-4337

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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