Provider Demographics
NPI:1437468675
Name:BERRY, PAMELA CLARE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:CLARE
Last Name:BERRY
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 1:6802 N BROOM TAIL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-9204
Mailing Address - Country:US
Mailing Address - Phone:520-300-1920
Mailing Address - Fax:
Practice Address - Street 1:6802 N BROOM TAIL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-9204
Practice Address - Country:US
Practice Address - Phone:520-300-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10493183500000X
AZ8991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist