Provider Demographics
NPI:1598757833
Name:BERGQUIST, CATHERINE ANGELA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANGELA
Last Name:BERGQUIST
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 1:376 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1004
Mailing Address - Country:US
Mailing Address - Phone:607-324-1257
Mailing Address - Fax:
Practice Address - Street 1:1 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1048
Practice Address - Country:US
Practice Address - Phone:607-324-6935
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist