Provider Demographics
NPI:1114365319
Name:BERTELSEN, PHILIP NEAL (PHARM D)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:NEAL
Last Name:BERTELSEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 COLUMBIA PARK TRL
Mailing Address - Street 2:APT #141D
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4822
Mailing Address - Country:US
Mailing Address - Phone:406-212-7622
Mailing Address - Fax:
Practice Address - Street 1:215 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5322
Practice Address - Country:US
Practice Address - Phone:509-547-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60329053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist