Provider Demographics
NPI:1265827760
Name:BERTSCH, RONALD DEAN (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:DEAN
Last Name:BERTSCH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 E 54TH ST N
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5563
Mailing Address - Country:US
Mailing Address - Phone:605-978-3930
Mailing Address - Fax:605-978-3994
Practice Address - Street 1:2503 E 54TH ST N
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5563
Practice Address - Country:US
Practice Address - Phone:605-978-3930
Practice Address - Fax:605-978-3994
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR4211183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist