Provider Demographics
NPI:1184224628
Name:HESSLER, BERTRAM EDWARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:BERTRAM
Middle Name:EDWARD
Last Name:HESSLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 CECIL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-7057
Mailing Address - Country:US
Mailing Address - Phone:573-346-2992
Mailing Address - Fax:573-346-2933
Practice Address - Street 1:94 CECIL ST
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-7057
Practice Address - Country:US
Practice Address - Phone:573-346-2992
Practice Address - Fax:573-346-2933
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140277571835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist