Provider Demographics
NPI:1124615638
Name:BERTRAND, TEENA M (RPH)
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:M
Last Name:BERTRAND
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 1:368-398 COTTAGE STREET
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861
Mailing Address - Country:US
Mailing Address - Phone:401-255-0729
Mailing Address - Fax:401-725-5090
Practice Address - Street 1:368-398 COTTAGE STREET
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861
Practice Address - Country:US
Practice Address - Phone:401-255-0729
Practice Address - Fax:401-725-5090
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH03507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist