Provider Demographics
NPI:1013687235
Name:BERTRAM RIPLEY PHARMACY
Entity Type:Organization
Organization Name:BERTRAM RIPLEY PHARMACY
Other - Org Name:BRISTOW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MS
Authorized Official - Phone:937-392-4020
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45167-1232
Mailing Address - Country:US
Mailing Address - Phone:937-392-4020
Mailing Address - Fax:937-392-4078
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-1232
Practice Address - Country:US
Practice Address - Phone:937-392-4020
Practice Address - Fax:937-392-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy