Healthcare Provider Details

I. General information

NPI: 1013193002
Provider Name (Legal Business Name): DAVID HARTTER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 KERCHEVAL AVE PHARMACY
GROSSE POINTE FARMS MI
48236-3610
US

IV. Provider business mailing address

5450 FORT ST PHARMACY
TRENTON MI
48183-4601
US

V. Phone/Fax

Practice location:
  • Phone: 313-640-2482
  • Fax: 313-343-8657
Mailing address:
  • Phone: 734-671-3839
  • Fax: 734-642-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302023164
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: