Provider Demographics
NPI:1275815607
Name:ADLER, BERNADETTE C (RPH)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:C
Last Name:ADLER
Suffix:
Gender:F
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:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-0906
Mailing Address - Country:US
Mailing Address - Phone:845-796-3600
Mailing Address - Fax:845-796-3601
Practice Address - Street 1:63 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1161
Practice Address - Country:US
Practice Address - Phone:845-796-3600
Practice Address - Fax:845-796-3601
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02920414Medicaid
NY02920414Medicaid