Provider Demographics
NPI:1497842363
Name:BARTLES PHARMACY INC
Entity Type:Organization
Organization Name:BARTLES PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:607-843-2841
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-0630
Mailing Address - Country:US
Mailing Address - Phone:607-843-2841
Mailing Address - Fax:607-843-6874
Practice Address - Street 1:10 LAFAYETTE PARK
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-0630
Practice Address - Country:US
Practice Address - Phone:607-843-2841
Practice Address - Fax:607-843-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0136523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2063388OtherPK
NY00451487Medicaid
0404150001Medicare NSC