MARY BERGSTROM (NPI# 1285234211) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285234211 |
| Entity Type | Individual |
| Full Name | MARY BERGSTROM |
| Credential | PHARM D |
| Practice Address |
6736 Lima Rd Fort Wayne IN 46818-1118 |
| Practice Telephone | 2604900638 |
| Mailing Telephone | 2604900638 |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | 5302030388 | MI | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | 26020791A | IN | Pharmacy Service Providers |
| Street Address |
6736 LIMA RD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46818-1118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295752665 | Sams East Inc | Durable Medical Equipment & Medical Supplies | 6736 Lima Rd, Fort Wayne, IN 46818-1118 | 2006-07-16 |
| 1558838912 | Curt Michael Esterline | Hearing Instrument Specialist | 6736 Lima Rd, Fort Wayne, IN 46818-1118 | 2018-10-24 |
| 1790267508 | Michelle Cooper | Pharmacist | 6736 Lima Rd, Fort Wayne, IN 46818-1118 | 2018-08-29 |
| 1861581662 | Sam's Club Optical | Technician/Technologist | 6736 Lima Rd, Fort Wayne, IN 46818-1118 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710464938 | Heather Smith | Day Training/Habilitation Specialist | 9434 Lima Road, Suite C, Fort Wayne, IN 46818 | 2018-07-20 |
| 1184146748 | Danielle Macias | Speech-Language Pathologist | 4935 Hillegas Road, Suite 200, Fort Wayne, IN 46818 | 2017-07-14 |
| 1801326533 | Kimberly M Kindt | Optometrist | 9426 Lima Rd Ste C, Fort Wayne, IN 46818 | 2017-06-15 |
| 1578983359 | Sarah Buzzard | Occupational Therapy Assistant | 9426 Lima Road, A, Fort Wayne, IN 46818 | 2014-04-21 |
| 1306196704 | Peter Yang Gaw Go | Occupational Therapist | 3406 Bluefield Place, Fort Wayne, IN 46818 | 2012-09-12 |
| 1043593536 | Carol Lynn Steinbach | Massage Therapist | 12101 Hand Rd., Fort Wayne, IN 46818 | 2011-09-21 |
| 1295058071 | Summit Nutrition Services, LLC | Dietitian, Registered | 3027 Mariposa Place, Fort Wayne, IN 46818 | 2010-03-08 |
| 1184871899 | The Arc of Northeast Indiana, Inc | Intermediate Care Facility, Mentally Retarded | 9104 Strathmore Lane, Fort Wayne, IN 46818 | 2008-08-25 |
| 1285851121 | Angela Coleman | Dentist | 10505 Lima Road, Fort Wayne, IN 46818 | 2007-04-20 |
| 1942335534 | Angela S King | Dentist | 9019 Lima Road, Fort Wayne, IN 46818 | 2007-02-22 |
| Find all providers in zip 46818 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347102 | Austin Hartzog | Pharmacist | 5110 Value Drive, Fort Wayne, IN 46808 | 2020-08-21 |
| 1528677622 | Leslie Renee Siegel | Pharmacist | 11109 Parkview Plaza Dr # 1, Fort Wayne, IN 46845-1701 | 2020-07-24 |
| 1962048140 | Andrew Quang Tran | Pharmacist | 6202 Saint Joe Center Rd, Fort Wayne, IN 46835-2506 | 2019-11-21 |
| 1467005991 | Nicholas Selby | Pharmacist | 6220 Saint Joe Center Rd, Fort Wayne, IN 46835-2506 | 2019-07-23 |
| 1215427042 | Jerry Eugene Falls | Pharmacist | 9817 Chapmans Blvd, Fort Wayne, IN 46835-9194 | 2018-05-17 |
| 1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
| 1063900611 | Juliette Peters | Pharmacist | 1900 Carew St Ste 4, Fort Wayne, IN 46805-4765 | 2018-04-30 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1790238350 | Karleen Goodwin | Pharmacist | 3964 New Vision Dr, Fort Wayne, IN 46845-1712 | 2016-08-01 |
| 1699131300 | Brent Alan Losier | Pharmacist | 3537 N Anthony Blvd, Suite A, Fort Wayne, IN 46805-1423 | 2016-01-11 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46818 |
Please comment or provide details below to improve the information on MARY BERGSTROM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.