Provider Demographics
NPI:1699395244
Name:BERMAN, IAN MATTHEW (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:MATTHEW
Last Name:BERMAN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1008
Mailing Address - Country:US
Mailing Address - Phone:973-460-4377
Mailing Address - Fax:
Practice Address - Street 1:515 INMAN AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-1114
Practice Address - Country:US
Practice Address - Phone:732-381-3400
Practice Address - Fax:732-381-3464
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03964900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist