Provider Demographics
NPI:1801393442
Name:BERGHAUS, JULIANNA M (RPH)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:M
Last Name:BERGHAUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JULIANNA
Other - Middle Name:M
Other - Last Name:ELSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:806 VALLEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1969
Mailing Address - Country:US
Mailing Address - Phone:573-330-7478
Mailing Address - Fax:573-747-1197
Practice Address - Street 1:806 VALLEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1969
Practice Address - Country:US
Practice Address - Phone:573-747-1191
Practice Address - Fax:573-747-1197
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist