Healthcare Provider Details

I. General information

NPI: 1114365319
Provider Name (Legal Business Name): PHILIP NEAL BERTELSEN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N 4TH AVE
PASCO WA
99301-5322
US

IV. Provider business mailing address

1775 COLUMBIA PARK TRL APT #141D
RICHLAND WA
99352-4822
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-2231
  • Fax:
Mailing address:
  • Phone: 406-212-7622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60329053
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: