Provider Demographics
NPI:1043814973
Name:BERGER-SHOULDERS, KEN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:BERGER-SHOULDERS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-4310
Mailing Address - Country:US
Mailing Address - Phone:812-422-6330
Mailing Address - Fax:
Practice Address - Street 1:2020 E MORGAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4310
Practice Address - Country:US
Practice Address - Phone:812-422-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017563A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist