Provider Demographics
NPI:1578023057
Name:BERTUMEN, MILES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:
Last Name:BERTUMEN
Suffix:
Gender:M
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:PSC 78 BOX 2675
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326-0027
Mailing Address - Country:US
Mailing Address - Phone:951-966-5045
Mailing Address - Fax:
Practice Address - Street 1:YOKOTA AIR BASE HOSPITAL
Practice Address - Street 2:BLDG 4408
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96326
Practice Address - Country:US
Practice Address - Phone:315-225-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist