Provider Demographics
NPI:1750627469
Name:BARTKO, DOUGLAS GEORGE (RPH)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:GEORGE
Last Name:BARTKO
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 1:2850 N LAZY MOUNTAIN DR
Mailing Address - Street 2:BOX 550
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8700
Mailing Address - Country:US
Mailing Address - Phone:907-775-0672
Mailing Address - Fax:
Practice Address - Street 1:2850 N LAZY MOUNTAIN DR
Practice Address - Street 2:BOX 550
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8700
Practice Address - Country:US
Practice Address - Phone:907-775-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist