Richard Bortle, R.PH.
Individual provider Active NPI Pharmacist · Caledonia, MI
NPI 1104293174 · NPPES record last updated Aug 26, 2015
Key facts
- NPI
- 1104293174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302025664 (MI)
- Practice address
- 1925 Marketplace Dr SE
Caledonia, MI 49316-8511 - Phone
- (810) 714-0975
- NPI assigned
- Aug 26, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302025664 | MI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302025664 | MI | Yes |
Addresses
Primary practice location
1925 Marketplace Dr SE
Caledonia, MI 49316-8511
Mailing address
1925 Marketplace Dr SE
Caledonia, MI 49316-8511
Phone (616) 528-2008
Other providers in Caledonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.