Provider Demographics
NPI:1578962668
Name:BERGERON, KATHERINE RICHARDSON (RPH)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:RICHARDSON
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 1:1932 REES ST
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4212
Mailing Address - Country:US
Mailing Address - Phone:337-332-1100
Mailing Address - Fax:337-332-1175
Practice Address - Street 1:1932 REES ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4212
Practice Address - Country:US
Practice Address - Phone:337-332-1100
Practice Address - Fax:337-332-1175
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist