Provider Demographics
NPI:1366466799
Name:BERTSCH, HEIDI J (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:BERTSCH
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17626 78TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-9311
Mailing Address - Country:US
Mailing Address - Phone:701-642-8997
Mailing Address - Fax:
Practice Address - Street 1:126 5TH ST N
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1421
Practice Address - Country:US
Practice Address - Phone:218-643-3871
Practice Address - Fax:218-643-1459
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117774-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist