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NPI Code Detail

MEDICARE: MR. JOHN ANTON BERG RPH

MEDICARE:  MR. JOHN ANTON BERG  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
1183500000XPharmacistP09437WA

General Provider Information

NPI Number : 1972588085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN ANTON BERG RPH
Provider Business Mailing Address
First Line : 5417 42ND AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98136-1508
Country : US
Telephone Number : 206-932-6615
Fax Number :
Provider Business Practice Location Address
First Line : 5417 42ND AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98136-1508
Country : US
Telephone Number : 206-932-6615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2005
Last Update Date : 07/08/2007

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Directions to “ MR. JOHN ANTON BERG RPH” Practice Location

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