Healthcare Provider Details

I. General information

NPI: 1104877158
Provider Name (Legal Business Name): ROBERT E HARTZELL RPH,CCN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AMERICAN ST
CATASAUQUA PA
18032-1800
US

IV. Provider business mailing address

1960 LINDEN LN
WHITEHALL PA
18052-3719
US

V. Phone/Fax

Practice location:
  • Phone: 610-264-5471
  • Fax: 610-264-8774
Mailing address:
  • Phone: 610-799-2470
  • Fax: 610-264-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberRP024948L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: