Provider Demographics
NPI:1437204336
Name:BERK, JEFFERY ARTHUR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:ARTHUR
Last Name:BERK
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 1:1829 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1096
Mailing Address - Country:US
Mailing Address - Phone:219-322-0641
Mailing Address - Fax:
Practice Address - Street 1:251 W 84TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE BRA
Practice Address - State:IN
Practice Address - Zip Code:46410-6243
Practice Address - Country:US
Practice Address - Phone:219-756-4340
Practice Address - Fax:219-756-4337
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN122381835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy