Healthcare Provider Details

I. General information

NPI: 1174729115
Provider Name (Legal Business Name): KEVIN RAY HARTMAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 STATE ST STE A
NASHVILLE TN
37203-1869
US

IV. Provider business mailing address

2222 STATE ST STE A
NASHVILLE TN
37203-1869
US

V. Phone/Fax

Practice location:
  • Phone: 615-371-1210
  • Fax: 615-371-1270
Mailing address:
  • Phone: 615-371-1210
  • Fax: 615-371-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9071
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: