MEDICARE: BERTOLINOS PHARMACY INC

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	PP410177L	PA
2	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	39-59749	OTHER	PA	PACO

General Provider Information

NPI Number	:	1962408419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERTOLINOS PHARMACY INC

Provider Business Mailing Address
First Line	:	1500 S 12TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-6202
Country	:	US
Telephone Number	:	215-389-5917
Fax Number	:	215-389-8685

Provider Business Practice Location Address
First Line	:	1500 S 12TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-6202
Country	:	US
Telephone Number	:	215-389-5917
Fax Number	:	215-389-5917

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. THOMAS MICHAEL BERTOLINO
Credential	:
Telephone Number	:	215-389-5917

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/07/2023

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Directions to “BERTOLINOS PHARMACY INC ” Practice Location

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