Provider Demographics
NPI:1699492066
Name:BERGEN, MYRON PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:MYRON
Middle Name:PAUL
Last Name:BERGEN
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 1:237 PIPELINE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7326
Mailing Address - Country:US
Mailing Address - Phone:817-282-2581
Mailing Address - Fax:
Practice Address - Street 1:237 PIPELINE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7326
Practice Address - Country:US
Practice Address - Phone:817-282-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist