Active NPI
Scott Roderick Bergeron, PHARMD., RPH
- Pharmacist
- Happy Valley, OR
National Provider Identifier
1962656108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0010850
- Practice address
- 9159 SE 82ND Ave
Happy Valley, OR 97086-3761 - Phone
- (503) 771-1386
- NPI assigned
- Nov 14, 2008
- Last updated
- Nov 18, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 52736 | TX | |
| Pharmacist | 183500000X | 41574 | TN | |
| Pharmacist | 183500000X | PH60091125 | WA | |
| Pharmacist | 183500000X | RPH-0010850 | OR | Primary |
Addresses
Primary practice location
9159 SE 82ND Ave
Happy Valley, OR 97086-3761
Mailing address
1025 W Trinity Mills Rd
Carrollton, TX 75006-1375
Phone (800) 273-3455
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
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0010850 | OR | MD | Pharmacist |
| 52736 | TX | MD | Pharmacist |
| PH60091125 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores Texas LLC | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Walmart Pharmacy 10-2625
- Community/Retail Pharmacy
- Carrollton, TX
- NPI 1215956222
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1962656108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 W TRINITY MILLS RD",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "750061375",
"telephone_number": "800-273-3455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9159 SE 82ND AVE",
"city": "HAPPY VALLEY",
"state": "OR",
"postal_code": "970863761",
"telephone_number": "503-771-1386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGERON",
"first_name": "SCOTT",
"middle_name": "RODERICK",
"credential": "PHARMD., RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-11-14",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "52736",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "41574",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60091125",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0010850",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Happy Valley, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.