MEDICARE: DR. RICHARD J. BERTIN RPH, PHD

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
1	183500000X	Pharmacist	RP025313L	PA

General Provider Information

NPI Number	:	1679572580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD J. BERTIN RPH, PHD

Provider Business Mailing Address
First Line	:	18617 TANTERRA WAY
Second Line	:
City	:	BROOKEVILLE
State	:	MD
Zip	:	20833-2817
Country	:	US
Telephone Number	:	202-223-7192
Fax Number	:	202-429-6304

Provider Business Practice Location Address
First Line	:	18617 TANTERRA WAY
Second Line	:
City	:	BROOKEVILLE
State	:	MD
Zip	:	20833-2817
Country	:	US
Telephone Number	:	202-223-7192
Fax Number	:	202-429-6304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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