Provider Demographics
NPI:1043839889
Name:SERGEANT, BERGEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BERGEN
Middle Name:
Last Name:SERGEANT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BERGEN
Other - Middle Name:
Other - Last Name:QUAERNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7101 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1436
Mailing Address - Country:US
Mailing Address - Phone:515-279-4408
Mailing Address - Fax:
Practice Address - Street 1:7101 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1436
Practice Address - Country:US
Practice Address - Phone:515-279-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist