Healthcare Provider Details

I. General information

NPI: 1356777577
Provider Name (Legal Business Name): MICHELLE LYNN BERT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FOSTER AVE
BALTIMORE MD
21224-3862
US

IV. Provider business mailing address

2809 BOSTON ST APT 427
BALTIMORE MD
21224-4814
US

V. Phone/Fax

Practice location:
  • Phone: 410-732-0523
  • Fax:
Mailing address:
  • Phone: 717-829-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20168
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: