MEDICARE: KEVIN BERTLING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH-0016021	OR

General Provider Information

NPI Number	:	1932623220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN BERTLING

Provider Business Mailing Address
First Line	:	9019 GARNERS FERRY RD STE C
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-9687
Country	:	US
Telephone Number	:	803-227-6890
Fax Number	:

Provider Business Practice Location Address
First Line	:	9019 GARNERS FERRY RD STE C
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-9687
Country	:	US
Telephone Number	:	803-227-6890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	05/02/2019

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Directions to “ KEVIN BERTLING ” Practice Location

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