Provider Demographics
NPI:1821635673
Name:BERTELS, SUZANN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SUZANN
Middle Name:
Last Name:BERTELS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4888 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1415
Mailing Address - Country:US
Mailing Address - Phone:248-276-3261
Mailing Address - Fax:248-276-2584
Practice Address - Street 1:4888 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MI
Practice Address - Zip Code:48306-1415
Practice Address - Country:US
Practice Address - Phone:248-276-3261
Practice Address - Fax:248-276-2584
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53151241821835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist