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	3336C0003X	Community/Retail Pharmacy		GA

General Provider Information

NPI Number	:	1609108000
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	:	PRESIDENT
Name	:	MR. LANCE PARKER BOLES
Credential	:	RPH, MBA
Telephone Number	:	706-376-5801

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	02/10/2010

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Directions to “HARTWELL RX, INC. ” Practice Location

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