Provider Demographics
NPI:1508468174
Name:CARLEY, BERGANDI ROSE (RPH)
Entity Type:Individual
Prefix:DR
First Name:BERGANDI
Middle Name:ROSE
Last Name:CARLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:BERGANDI
Other - Middle Name:ROSE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:814 TIPPIT ST
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1270
Mailing Address - Country:US
Mailing Address - Phone:618-771-7223
Mailing Address - Fax:
Practice Address - Street 1:1600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2120
Practice Address - Country:US
Practice Address - Phone:618-457-8397
Practice Address - Fax:618-549-3052
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist