Provider Demographics
NPI:1427447747
Name:BERGERON, SANDY YUEN SHAN (RPH)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:YUEN SHAN
Last Name:BERGERON
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 1:150 CONCORD COMMONS PL SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5026
Mailing Address - Country:US
Mailing Address - Phone:704-788-3138
Mailing Address - Fax:704-784-9604
Practice Address - Street 1:150 CONCORD COMMONS PL SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5026
Practice Address - Country:US
Practice Address - Phone:704-788-3138
Practice Address - Fax:704-784-9604
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist