Active NPI
Bertram Georgetown Pharmacy
- Community/Retail Pharmacy
- Georgetown, OH
National Provider Identifier
1720759996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- BERTRAM GEORGETOWN PHARMACY
- Practice address
- 114 S Main St
Georgetown, OH 45121-1221 - Phone
- (937) 378-4844
- Fax
- (937) 378-4226
- NPI assigned
- Sep 27, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Alexander Bertram, PHARMD, MS
- Title
- Owner
- Phone
- (937) 378-4844
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
114 S Main St
Georgetown, OH 45121-1221
Mailing address
114 S Main St
Georgetown, OH 45121-1221
Phone (937) 378-4844
Other names 1
- Donohoo Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220406002746 | OH | Part B Supplier - Pharmacy | 0547656183 | Practice locations: Georgetown, OH |
National Provider Directory
National Provider Directory- Tax ID family
- Bertram Georgetown Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Georgetown, OH
- NPI 1679386395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632700800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1642636800000",
"number": "1720759996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 S MAIN ST",
"city": "GEORGETOWN",
"state": "OH",
"postal_code": "451211221",
"telephone_number": "937-378-4844",
"fax_number": "937-378-4226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 S MAIN ST",
"city": "GEORGETOWN",
"state": "OH",
"postal_code": "451211221",
"telephone_number": "937-378-4844",
"fax_number": "937-378-4226"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BERTRAM GEORGETOWN PHARMACY",
"organizational_subpart": "NO",
"enumeration_date": "2021-09-27",
"last_updated": "2022-01-20",
"certification_date": "2022-01-20",
"status": "A",
"authorized_official_last_name": "BERTRAM",
"authorized_official_first_name": "ALEXANDER",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "937-378-4844",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHARMD, MS"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Donohoo Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Donohoo Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Georgetown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.