Provider Demographics
NPI:1871594317
Name:BERTKE, DALE A (RPH)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:A
Last Name:BERTKE
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 1:15203 SCHMITMEYER BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-9362
Mailing Address - Country:US
Mailing Address - Phone:419-628-1607
Mailing Address - Fax:
Practice Address - Street 1:120 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1507
Practice Address - Country:US
Practice Address - Phone:419-678-9000
Practice Address - Fax:419-678-8511
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-15995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist