Provider Demographics
NPI:1396390613
Name:BERGERON, PATIENCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 KEELINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-3254
Mailing Address - Country:US
Mailing Address - Phone:337-519-4194
Mailing Address - Fax:
Practice Address - Street 1:704 N PARKERSON AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4355
Practice Address - Country:US
Practice Address - Phone:337-783-9084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist