Provider Demographics
NPI:1942582556
Name:BARTELS, KEVIN ALAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALAN
Last Name:BARTELS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3837
Mailing Address - Country:US
Mailing Address - Phone:320-251-9433
Mailing Address - Fax:320-251-5007
Practice Address - Street 1:2505 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3837
Practice Address - Country:US
Practice Address - Phone:320-251-9433
Practice Address - Fax:320-251-5007
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist