Provider Demographics
NPI:1598069585
Name:ERTLE, BARBARA ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELIZABETH
Last Name:ERTLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 WILLOWBOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8261
Mailing Address - Country:US
Mailing Address - Phone:443-939-4470
Mailing Address - Fax:
Practice Address - Street 1:1220 HIGHWWAY 321 NORTHWEST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-324-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist