Provider Demographics
NPI:1265490007
Name:BERGS PHARMACY INC
Entity Type:Organization
Organization Name:BERGS PHARMACY INC
Other - Org Name:BERGS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-362-8500
Mailing Address - Street 1:103 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56096-1444
Mailing Address - Country:US
Mailing Address - Phone:507-362-8500
Mailing Address - Fax:507-362-8090
Practice Address - Street 1:103 3RD ST S
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:MN
Practice Address - Zip Code:56096-1444
Practice Address - Country:US
Practice Address - Phone:507-362-8500
Practice Address - Fax:507-362-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2608283336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN108558100Medicaid
2045165OtherPK
MN108558100Medicaid