Provider Demographics
NPI:1992122428
Name:BARTZ, SANDI (RPH)
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:BARTZ
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 1:1200 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2687
Mailing Address - Country:US
Mailing Address - Phone:507-537-9650
Mailing Address - Fax:507-537-9646
Practice Address - Street 1:1200 SUSAN DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2687
Practice Address - Country:US
Practice Address - Phone:507-537-9650
Practice Address - Fax:507-537-9646
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist