Provider Demographics
NPI:1619359981
Name:BERGMAN, ANDREW JASON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JASON
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 MORNING GLORY PASS
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IN
Mailing Address - Zip Code:46743-7553
Mailing Address - Country:US
Mailing Address - Phone:260-437-9001
Mailing Address - Fax:
Practice Address - Street 1:6309 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1425
Practice Address - Country:US
Practice Address - Phone:260-497-1033
Practice Address - Fax:260-497-1065
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026041A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy