Provider Demographics
NPI:1396713921
Name:BERNEKING, FREDERICK MORGAN (PHARM D)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:MORGAN
Last Name:BERNEKING
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 LOMA ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5606
Mailing Address - Country:US
Mailing Address - Phone:319-232-1375
Mailing Address - Fax:
Practice Address - Street 1:1717 W RIDGEWAY AVE
Practice Address - Street 2:SUITE 50A
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4543
Practice Address - Country:US
Practice Address - Phone:319-833-5838
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA153971835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy