Provider Demographics
NPI:1417294521
Name:BERTONI, ANDREA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:BERTONI
Suffix:
Gender:F
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:PO BOX 2718
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2718
Mailing Address - Country:US
Mailing Address - Phone:800-552-1827
Mailing Address - Fax:
Practice Address - Street 1:3500 SE 26TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2901
Practice Address - Country:US
Practice Address - Phone:503-797-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist