Provider Demographics
NPI:1578872768
Name:BERGMANN, MAGRIT
Entity Type:Individual
Prefix:MRS
First Name:MAGRIT
Middle Name:
Last Name:BERGMANN
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:PO BOX 411
Mailing Address - Street 2:9381 RANGER TRAIL
Mailing Address - City:OREGON HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95962
Mailing Address - Country:US
Mailing Address - Phone:530-692-0644
Mailing Address - Fax:
Practice Address - Street 1:2805 BELL ROAD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:530-823-8125
Practice Address - Fax:530-823-8179
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist