Healthcare Provider Details

I. General information

NPI: 1922041680
Provider Name (Legal Business Name): HARTFORD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W. HIGHWAY 38 SUITE 102
HARTFORD SD
57033-0397
US

IV. Provider business mailing address

PO BOX 397
HARTFORD SD
57033-0397
US

V. Phone/Fax

Practice location:
  • Phone: 605-528-2000
  • Fax: 605-528-2003
Mailing address:
  • Phone: 605-528-2000
  • Fax: 605-528-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number100-1873
License Number StateSD

VIII. Authorized Official

Name: MR. VINCENT GERARD REILLY
Title or Position: MEMBER MANAGER
Credential: RPH
Phone: 605-528-2000