Provider Demographics
NPI:1548786122
Name:BERKS PHARMACY LLC
Entity Type:Organization
Organization Name:BERKS PHARMACY LLC
Other - Org Name:BERKS DISCOUNT PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PUSHPALU
Authorized Official - Middle Name:
Authorized Official - Last Name:PALADUGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-373-1800
Mailing Address - Street 1:500 PENN ST STE B
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19602-1085
Mailing Address - Country:US
Mailing Address - Phone:610-373-1800
Mailing Address - Fax:610-373-1818
Practice Address - Street 1:500 PENN ST STE B
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-1085
Practice Address - Country:US
Practice Address - Phone:610-373-1800
Practice Address - Fax:610-373-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4824443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170869OtherPK
PA1033654380001Medicaid