Provider Demographics
NPI:1255885406
Name:VOUFFO, BERTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:BERTIN
Middle Name:
Last Name:VOUFFO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CYPRESS PT
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-4913
Mailing Address - Country:US
Mailing Address - Phone:240-330-0728
Mailing Address - Fax:
Practice Address - Street 1:5709 W AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4003
Practice Address - Country:US
Practice Address - Phone:806-355-7209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist