Provider Demographics
NPI:1063743532
Name:BARTOSH, JODIE
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:
Last Name:BARTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 FM 3006
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-6702
Mailing Address - Country:US
Mailing Address - Phone:210-792-3928
Mailing Address - Fax:
Practice Address - Street 1:735 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1642
Practice Address - Country:US
Practice Address - Phone:210-927-6875
Practice Address - Fax:210-922-4789
Is Sole Proprietor?:No
Enumeration Date:2010-01-23
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist