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General NPI Number Information
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NPI Number | 1063799559
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Entity Type | Individual
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Provider Name | THERESA HURST
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Gender | Female
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 2301 E MARKET ST
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City | LOGANSPORT
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State | IN
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Zip | 46947-2037
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Country | US
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Telephone | 574-735-3815
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Fax | 574-739-0824
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Provider Business Mailing Address
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Address Line | 990 E 700 N
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City | DELPHI
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State | IN
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Zip | 46923-8374
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26018056A
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License Number State | IN
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