Provider Demographics
NPI:1639770217
Name:BERGMAN, NANCY ANN (DPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5065
Mailing Address - Country:US
Mailing Address - Phone:405-412-0571
Mailing Address - Fax:
Practice Address - Street 1:333 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6326
Practice Address - Country:US
Practice Address - Phone:405-329-5761
Practice Address - Fax:405-329-5774
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist