Provider Demographics
NPI:1437497898
Name:BIERWAGEN, MARK T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:BIERWAGEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 N SPRING GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2560
Mailing Address - Country:US
Mailing Address - Phone:386-736-7318
Mailing Address - Fax:386-943-8123
Practice Address - Street 1:937 N SPRING GARDEN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2560
Practice Address - Country:US
Practice Address - Phone:386-736-7318
Practice Address - Fax:386-943-8123
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist