Provider Demographics
NPI:1386931418
Name:BERKI, EDWARD JAMES
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:BERKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:JAMES
Other - Last Name:BERKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:130 W GUADALUPE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3328
Mailing Address - Country:US
Mailing Address - Phone:480-503-2245
Mailing Address - Fax:480-858-9148
Practice Address - Street 1:3232 S MILL AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3656
Practice Address - Country:US
Practice Address - Phone:480-858-9044
Practice Address - Fax:480-858-9148
Is Sole Proprietor?:No
Enumeration Date:2011-07-10
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist