Provider Demographics
NPI:1144830373
Name:BERGERON, KAITLYN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD STE N116
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3152
Mailing Address - Country:US
Mailing Address - Phone:504-349-6185
Mailing Address - Fax:504-349-6188
Practice Address - Street 1:1111 MEDICAL CENTER BLVD STE N116
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3152
Practice Address - Country:US
Practice Address - Phone:504-349-6185
Practice Address - Fax:504-349-6188
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist