Healthcare Provider Details

I. General information

NPI: 1215941570
Provider Name (Legal Business Name): BERNARD L VANPELT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3278 MITCHELL BLVD BLDG 900
MOODY AFB GA
31699-1800
US

IV. Provider business mailing address

3278 MITCHELL BLVD BLDG 900
MOODY AFB GA
31699-7869
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-3011
  • Fax: 229-257-2345
Mailing address:
  • Phone: 229-257-3014
  • Fax: 229-257-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042510
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: