Provider Demographics
NPI:1194471730
Name:BERTELSON, BRETT (RPH)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BERTELSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8305
Mailing Address - Country:US
Mailing Address - Phone:763-270-7473
Mailing Address - Fax:763-295-6177
Practice Address - Street 1:216 W 7TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8305
Practice Address - Country:US
Practice Address - Phone:763-270-7473
Practice Address - Fax:763-295-6177
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist