Provider Demographics
NPI:1598042954
Name:BERTOLINO, MEGAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:BERTOLINO
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 1:108 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1404
Mailing Address - Country:US
Mailing Address - Phone:217-562-2770
Mailing Address - Fax:217-562-2778
Practice Address - Street 1:108 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1404
Practice Address - Country:US
Practice Address - Phone:217-562-2770
Practice Address - Fax:217-562-2778
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist