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General NPI Number Information
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NPI Number | 1952855934
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Entity Type | Individual
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Provider Name | ALYSSA ASHLEE BERTRAM
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Gender | Female
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 675 BALTIMORE DR
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City | WILKES BARRE
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State | PA
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Zip | 18702-7900
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Country | US
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Telephone | 570-808-7524
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Fax |
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Provider Business Mailing Address
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Address Line | 206 HAVERFORD DR
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City | WILKES BARRE
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State | PA
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Zip | 18702-7232
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Country | US
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Telephone | 570-709-2153
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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 | RP450729
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License Number State | PA
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