Healthcare Provider Details

I. General information

NPI: 1831385889
Provider Name (Legal Business Name): GEORGE HARTMAN III R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 09/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 2ND ST
FORT LUPTON CO
80621-1745
US

IV. Provider business mailing address

2514 EVANS AVE
LOUISVILLE CO
80027-1215
US

V. Phone/Fax

Practice location:
  • Phone: 303-857-1502
  • Fax:
Mailing address:
  • Phone: 303-665-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11666
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: