MEDICARE: DR. THOMAS MICHAEL BERTNICK PHARMD

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	PS36316	FL

General Provider Information

NPI Number	:	1952649832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS MICHAEL BERTNICK PHARMD

Provider Business Mailing Address
First Line	:	2201 CANOE CREEK LN
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34981-4938
Country	:	US
Telephone Number	:	772-801-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 S FEDERAL HWY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5922
Country	:	US
Telephone Number	:	772-467-2188
Fax Number	:	772-467-2189

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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