Provider Demographics
NPI:1205120474
Name:BERTHOLD, CAITLIN K (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:K
Last Name:BERTHOLD
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 1:11 W CURRAN DR
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-1309
Mailing Address - Country:US
Mailing Address - Phone:609-641-2489
Mailing Address - Fax:
Practice Address - Street 1:636 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-2302
Practice Address - Country:US
Practice Address - Phone:609-484-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03400600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist