Provider Demographics
NPI:1336462761
Name:KOERTGE, BRET A (PHARMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:A
Last Name:KOERTGE
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 EXETER RD UNIT 80-454
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3963
Mailing Address - Country:US
Mailing Address - Phone:901-687-7170
Mailing Address - Fax:
Practice Address - Street 1:3440 N 16TH ST # 203
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7125
Practice Address - Country:US
Practice Address - Phone:602-807-6799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR-17333183500000X
ORRPH-0017930183500000X
MST-14431183500000X
TX66305183500000X
VA202218476183500000X
AL21467183500000X
TN33685183500000X
AZS024593183500000X
MD22079183500000X
IN26023762A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist