Provider Demographics
NPI:1780978056
Name:BERGER, KRISTIN ERIKA (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ERIKA
Last Name:BERGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 N ANKENY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4611
Mailing Address - Country:US
Mailing Address - Phone:515-965-4680
Mailing Address - Fax:
Practice Address - Street 1:3625 N ANKENY BLVD STE A
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4611
Practice Address - Country:US
Practice Address - Phone:515-965-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20004183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist