Provider Demographics
NPI:1992145585
Name:BERTONCINI, GREGORY ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ROBERT
Last Name:BERTONCINI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 TAUNTON DEPOT DR
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-6915
Mailing Address - Country:US
Mailing Address - Phone:508-824-5848
Mailing Address - Fax:508-692-6590
Practice Address - Street 1:81 TAUNTON DEPOT DR
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-6915
Practice Address - Country:US
Practice Address - Phone:508-824-5848
Practice Address - Fax:508-692-6590
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist