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General NPI Number Information
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NPI Number | 1952649832
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Entity Type | Individual
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Provider Name | THOMAS MICHAEL BERTNICK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 2517 S FEDERAL HWY
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City | FORT PIERCE
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State | FL
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Zip | 34982-5922
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Country | US
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Telephone | 772-467-2188
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Fax | 772-467-2189
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Provider Business Mailing Address
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Address Line | 2201 CANOE CREEK LN
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City | FORT PIERCE
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State | FL
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Zip | 34981-4938
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Country | US
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Telephone | 772-801-5050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS36316
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License Number State | FL
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