Provider Demographics
NPI:1568461366
Name:BERT'S PHARMACY, INC.
Entity Type:Organization
Organization Name:BERT'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRETTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-888-2394
Mailing Address - Street 1:144 DESMOND ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2002
Mailing Address - Country:US
Mailing Address - Phone:570-888-2394
Mailing Address - Fax:570-888-4482
Practice Address - Street 1:144 DESMOND ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2002
Practice Address - Country:US
Practice Address - Phone:570-888-2394
Practice Address - Fax:570-888-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005842870001Medicaid
NY01019878Medicaid
PA0401170001Medicare ID - Type Unspecified