Provider Demographics
NPI:1508329178
Name:BERKOVICH, MARIYA ALEKSANDROVNA
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:ALEKSANDROVNA
Last Name:BERKOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1956
Mailing Address - Country:US
Mailing Address - Phone:248-632-7731
Mailing Address - Fax:
Practice Address - Street 1:2990 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1414
Practice Address - Country:US
Practice Address - Phone:248-541-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician