Provider Demographics
NPI:1912125402
Name:BARTLETT, PEGGY JAN (RPH)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JAN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5477
Mailing Address - Country:US
Mailing Address - Phone:701-223-1656
Mailing Address - Fax:701-223-9628
Practice Address - Street 1:835 S WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5477
Practice Address - Country:US
Practice Address - Phone:701-223-1656
Practice Address - Fax:701-223-9628
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND24857OtherBC BS INDIVIDUAL PROVIDER