Provider Demographics
NPI:1831304096
Name:BERGER, RANDALL (RPH)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:BERGER
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 1:14181 WOODS MILL COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3439
Mailing Address - Country:US
Mailing Address - Phone:314-724-1132
Mailing Address - Fax:
Practice Address - Street 1:7010 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-4318
Practice Address - Country:US
Practice Address - Phone:314-727-4854
Practice Address - Fax:314-727-1724
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist