Provider Demographics
NPI:1083658900
Name:BERK, STEPHEN GENE (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GENE
Last Name:BERK
Suffix:
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 1:5329 WESLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765
Mailing Address - Country:US
Mailing Address - Phone:916-449-5988
Mailing Address - Fax:916-449-5959
Practice Address - Street 1:1616 CAPITOL AVW
Practice Address - Street 2:MS 7700
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814
Practice Address - Country:US
Practice Address - Phone:916-449-5988
Practice Address - Fax:916-449-5959
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist