Active NPI
Matthew Berg, PHARMD
- Pharmacist
- Auburn, WA
National Provider Identifier
1972964138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH60303556
- Practice address
- 17500 SE 392ND St
Auburn, WA 98092-9705 - Phone
- (253) 333-3619
- Fax
- (253) 333-6853
- NPI assigned
- Mar 16, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH60303556 | WA | Primary |
Addresses
Primary practice location
17500 SE 392ND St
Auburn, WA 98092-9705
Mailing address
17500 SE 392ND St
Auburn, WA 98092-9705
Phone (253) 333-3619
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH60303556 | Other | WA | WASHINGTON STATE DEPARTMENT OF HEALTH |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH60303556 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458086400000",
"number": "1972964138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17500 SE 392ND ST",
"city": "AUBURN",
"state": "WA",
"postal_code": "980929705",
"telephone_number": "253-333-3619",
"fax_number": "253-333-6853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17500 SE 392ND ST",
"city": "AUBURN",
"state": "WA",
"postal_code": "980929705",
"telephone_number": "253-333-3619",
"fax_number": "253-333-6853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "MATTHEW",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-16",
"last_updated": "2016-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60303556",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
"identifier": "PH60303556",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Auburn, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.