Healthcare Provider Details

I. General information

NPI: 1053921833
Provider Name (Legal Business Name): DANE BARTHULE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 S MILLER RD
BUCKEYE AZ
85326-6989
US

IV. Provider business mailing address

4625 S MILLER RD
BUCKEYE AZ
85326-6989
US

V. Phone/Fax

Practice location:
  • Phone: 480-351-7440
  • Fax:
Mailing address:
  • Phone: 480-351-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS024763
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: