MEDICARE: MS. DARLENE HURST R.PH.

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	31899	TX
2	183500000X	Pharmacist	20170	GA

General Provider Information

NPI Number	:	1871586339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARLENE HURST R.PH.

Provider Business Mailing Address
First Line	:	4143 DIVOT WAY
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8190
Country	:	US
Telephone Number	:	678-472-6074
Fax Number	:	404-778-4571

Provider Business Practice Location Address
First Line	:	1365-C CLIFTON RD NE
Second Line	:	WINSHIP INFUSION PHARMACY
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-4562
Fax Number	:	404-778-4571

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	11/15/2010

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