Provider Demographics
NPI:1639473101
Name:BERGER, KENNETH A (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:BERGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 7TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1734
Mailing Address - Country:US
Mailing Address - Phone:304-522-6677
Mailing Address - Fax:304-522-4061
Practice Address - Street 1:19 7TH AVE W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1734
Practice Address - Country:US
Practice Address - Phone:304-522-6677
Practice Address - Fax:304-522-4061
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist