Provider Demographics
NPI:1407136542
Name:BERA, RIDDHI (RPH)
Entity Type:Individual
Prefix:
First Name:RIDDHI
Middle Name:
Last Name:BERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 113TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6588
Mailing Address - Country:US
Mailing Address - Phone:718-520-5499
Mailing Address - Fax:
Practice Address - Street 1:9514 63RD DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2025
Practice Address - Country:US
Practice Address - Phone:718-896-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist