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General NPI Number Information
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NPI Number | 1962408419
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Entity Type | Organization
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Legal Business Name | BERTOLINOS PHARMACY INC
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1500 S 12TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-6202
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Country | US
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Telephone | 215-389-5917
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Fax | 215-389-5917
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Provider Business Mailing Address
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Address Line | 1500 S 12TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-6202
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Country | US
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Telephone | 215-389-5917
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Fax | 215-389-8685
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. THOMAS MICHAEL BERTOLINO
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Credential |
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Telephone | 215-389-5917
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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 | PP410177L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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