Provider Demographics
NPI:1740775147
Name:BERG, REBECCA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7303 BENNINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8947
Mailing Address - Country:US
Mailing Address - Phone:330-398-8636
Mailing Address - Fax:
Practice Address - Street 1:1400 S ARLINGTON ST UNIT 38
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306
Practice Address - Country:US
Practice Address - Phone:330-564-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist