MEDICARE: GARY HATFIELD II PHARM D

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	183500000X	Pharmacist	RP0011572	WV

General Provider Information

NPI Number	:	1467007773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY HATFIELD II PHARM D

Provider Business Mailing Address
First Line	:	1492 TIMS FORK RD
Second Line	:
City	:	CHAPMANVILLE
State	:	WV
Zip	:	25508-7142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4016 OHIO RIVER RD
Second Line	:
City	:	POINT PLEASANT
State	:	WV
Zip	:	25550-3257
Country	:	US
Telephone Number	:	304-675-1612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2019
Last Update Date	:	08/04/2019

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