Provider Demographics
NPI:1477711505
Name:BERTI, EILEEN ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:ANN
Last Name:BERTI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:ANN
Other - Last Name:BERTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:320 POMFRET STREET
Mailing Address - Street 2:DAY KIMBALL HOSPITAL PHARMACY
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260
Mailing Address - Country:US
Mailing Address - Phone:860-963-6361
Mailing Address - Fax:860-963-6435
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:DAY KIMBALL HOSPITAL PHARMACY
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-963-6361
Practice Address - Fax:860-963-6435
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist