Provider Demographics
NPI:1205123627
Name:BERGEY, BRIAN K (PHARMD, RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:BERGEY
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 BUFFALO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-2537
Mailing Address - Country:US
Mailing Address - Phone:919-498-1962
Mailing Address - Fax:919-498-2077
Practice Address - Street 1:1655 BUFFALO LAKE RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-2537
Practice Address - Country:US
Practice Address - Phone:919-498-1962
Practice Address - Fax:919-498-2077
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist