Healthcare Provider Details

I. General information

NPI: 1386124352
Provider Name (Legal Business Name): KEVIN R HRTYANSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2018
Last Update Date: 08/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N FRASER ST
GEORGETOWN SC
29440-2800
US

IV. Provider business mailing address

264 SHERWOOD DR
MURRELLS INLET SC
29576-9374
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-2223
  • Fax:
Mailing address:
  • Phone: 304-550-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030654L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0004714
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37642
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: