Provider Demographics
NPI:1720360621
Name:BERK, RONALD MARSHALL (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:MARSHALL
Last Name:BERK
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 1:21730 CONSTITUTION ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5518
Mailing Address - Country:US
Mailing Address - Phone:248-352-3597
Mailing Address - Fax:
Practice Address - Street 1:30852 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0920
Practice Address - Country:US
Practice Address - Phone:248-549-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist