Provider Demographics
NPI:1982289351
Name:BERGMANN, TAYLOR LAUREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LAUREN
Last Name:BERGMANN
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 1:400 S ROSE ST APT 430
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5235
Mailing Address - Country:US
Mailing Address - Phone:716-435-9575
Mailing Address - Fax:
Practice Address - Street 1:5991 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8386
Practice Address - Country:US
Practice Address - Phone:269-979-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist