Individual
BILL-BERN BALTHAZARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1555 N TOMAHAWK ISLAND DR, PORTLAND, OR 97217-7912
(503) 205-9110
Mailing address
3250 NE BROADWAY ST APT 240, PORTLAND, OR 97232-3462
(484) 274-1910
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CPT-0012541
OR
183700000X
Pharmacy Technician
VA61112817
WA
Other
Enumeration date
12/18/2020
Last updated
12/18/2020
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