Provider Demographics
NPI:1376847665
Name:BERGER, GARY H (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:H
Last Name:BERGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2608
Mailing Address - Country:US
Mailing Address - Phone:310-260-0263
Mailing Address - Fax:310-395-1392
Practice Address - Street 1:710 BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2608
Practice Address - Country:US
Practice Address - Phone:310-260-0263
Practice Address - Fax:310-395-1392
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-31
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA027594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist