Provider Demographics
NPI:1245677079
Name:BERGIN, MADELINE (RPH)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:BERGIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TROWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3660
Mailing Address - Country:US
Mailing Address - Phone:508-743-9563
Mailing Address - Fax:508-743-0206
Practice Address - Street 1:1 TROWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3660
Practice Address - Country:US
Practice Address - Phone:508-743-9563
Practice Address - Fax:508-743-0206
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist