Active NPI
Holly Bergeron, RPH
- Pharmacist
- Indianapolis, IN
National Provider Identifier
1770850927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS33969
- Practice address
- 1505 E 86TH Street
Indianapolis, IN 46240 - Phone
- (317) 254-9206
- NPI assigned
- Nov 16, 2011
- Last updated
- Nov 16, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS33969 | FL | Primary |
| Pharmacist | 183500000X | 26020424A | IN |
Addresses
Primary practice location
1505 E 86TH Street
Indianapolis, IN 46240
Mailing address
1505 E 86TH St
Indianapolis, IN 46240-2392
Phone (317) 254-9206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS33969 | FL | MD | Pharmacist |
| 26020424A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321401600000",
"number": "1770850927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 E 86TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462402392",
"telephone_number": "317-254-9206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 E 86TH STREET",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46240",
"telephone_number": "317-254-9206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGERON",
"first_name": "HOLLY",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-16",
"last_updated": "2011-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS33969",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26020424A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.