Provider Demographics
NPI:1700228616
Name:BERG, DAVID CURTIS (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CURTIS
Last Name:BERG
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 1:5727 SILVER FALLS ST
Mailing Address - Street 2:APT E
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-1355
Mailing Address - Country:US
Mailing Address - Phone:612-414-8466
Mailing Address - Fax:
Practice Address - Street 1:4890 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1552
Practice Address - Country:US
Practice Address - Phone:614-261-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist