Provider Demographics
NPI:1679856389
Name:BARTELS, KATIE LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:LYNN
Last Name:BARTELS
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 1:430 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-1634
Mailing Address - Country:US
Mailing Address - Phone:618-792-5758
Mailing Address - Fax:
Practice Address - Street 1:18 W EDWARDSVILLE RD
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1214
Practice Address - Country:US
Practice Address - Phone:618-254-3873
Practice Address - Fax:618-254-5292
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293551183500000X
MO2010031676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist