Provider Demographics
NPI:1548852270
Name:BERKOVSKY, CHARLES JOHN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOHN
Last Name:BERKOVSKY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-3603
Mailing Address - Country:US
Mailing Address - Phone:361-275-3411
Mailing Address - Fax:361-275-3783
Practice Address - Street 1:515 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-3603
Practice Address - Country:US
Practice Address - Phone:361-275-3411
Practice Address - Fax:361-275-3783
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist