Provider Demographics
NPI:1548748833
Name:BERGERON, EMILY ROSE (RPH)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:BERGERON
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 1:4 DAPHNE CT
Mailing Address - Street 2:
Mailing Address - City:PENACOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03303-3415
Mailing Address - Country:US
Mailing Address - Phone:603-491-7173
Mailing Address - Fax:
Practice Address - Street 1:41 CARROLL ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:NH
Practice Address - Zip Code:03263-3301
Practice Address - Country:US
Practice Address - Phone:603-435-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-04469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist