Healthcare Provider Details

I. General information

NPI: 1912812744
Provider Name (Legal Business Name): SAMUEL JASON HARTNETT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MIKES PIKE ST
WINSLOW AZ
86047-2400
US

IV. Provider business mailing address

700 MIKES PIKE ST
WINSLOW AZ
86047-2400
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-3301
  • Fax:
Mailing address:
  • Phone: 928-289-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS028046
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: