Healthcare Provider Details

I. General information

NPI: 1366466799
Provider Name (Legal Business Name): HEIDI J BERTSCH PHARM D, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 5TH ST N
BRECKENRIDGE MN
56520-1421
US

IV. Provider business mailing address

17626 78TH ST SE
WAHPETON ND
58075-9311
US

V. Phone/Fax

Practice location:
  • Phone: 218-643-3871
  • Fax: 218-643-1459
Mailing address:
  • Phone: 701-642-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117774-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: