Provider Demographics
NPI:1659437150
Name:BARTLE, BRIAN W (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:BARTLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-4325
Mailing Address - Country:US
Mailing Address - Phone:607-843-8254
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist