Provider Demographics
NPI:1730153487
Name:BERKOFSKY, ELI ROBERT (CRPH)
Entity type:Individual
Prefix:MR
First Name:ELI
Middle Name:ROBERT
Last Name:BERKOFSKY
Suffix:
Gender:M
Credentials:CRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13470 BROWN BEAR RUN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6445
Mailing Address - Country:US
Mailing Address - Phone:239-691-3171
Mailing Address - Fax:
Practice Address - Street 1:13470 BROWN BEAR RUN
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6445
Practice Address - Country:US
Practice Address - Phone:239-691-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS13682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689240096Medicaid