Provider Demographics
NPI:1811125271
Name:BERCHERT, EDMUND STEFAN III (RPH)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:STEFAN
Last Name:BERCHERT
Suffix:III
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 1:3688 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3620
Mailing Address - Country:US
Mailing Address - Phone:330-225-0202
Mailing Address - Fax:330-273-1876
Practice Address - Street 1:3688 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3620
Practice Address - Country:US
Practice Address - Phone:330-225-0202
Practice Address - Fax:330-273-1876
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist