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NPI Code Detail

MEDICARE: DR. BENJAMIN K BERTSCHE

MEDICARE: DR. BENJAMIN K BERTSCHE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03234118OH

General Provider Information

NPI Number : 1053940395
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN K BERTSCHE
Provider Business Mailing Address
First Line : 7125 HARTCREST LN
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4882
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1331 N FAIRFIELD RD
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45432-2643
Country : US
Telephone Number : 937-426-4478
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2020
Last Update Date : 04/08/2020

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