MEDICARE: HARTWELL RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHRE009635	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2124561	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154546646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARTWELL RX INC

Provider Business Mailing Address
First Line	:	118 ATHENS ST
Second Line	:
City	:	HARTWELL
State	:	GA
Zip	:	30643-1851
Country	:	US
Telephone Number	:	706-376-5801
Fax Number	:	706-376-8687

Provider Business Practice Location Address
First Line	:	118 ATHENS ST
Second Line	:
City	:	HARTWELL
State	:	GA
Zip	:	30643-1851
Country	:	US
Telephone Number	:	706-376-5801
Fax Number	:	706-376-8687

Authorized Official
Title or Position	:	OWNER, AO
Name	:	LANCE BOLES
Credential	:
Telephone Number	:	706-376-5801

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/19/2018

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Directions to “HARTWELL RX INC ” Practice Location

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