Provider Demographics
NPI:1477140846
Name:BERKEN, CHARLES NICHOLAS
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:NICHOLAS
Last Name:BERKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SEAL LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4750
Mailing Address - Country:US
Mailing Address - Phone:484-326-8894
Mailing Address - Fax:
Practice Address - Street 1:141 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2615
Practice Address - Country:US
Practice Address - Phone:610-363-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist