Provider Demographics
NPI:1760234652
Name:BERBERICH, ANTHONY GLENN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GLENN
Last Name:BERBERICH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 TRAILS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-3353
Mailing Address - Country:US
Mailing Address - Phone:330-774-5024
Mailing Address - Fax:
Practice Address - Street 1:713 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1750
Practice Address - Country:US
Practice Address - Phone:330-545-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist