MEDICARE: KURT HETLER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11218	AL

General Provider Information

NPI Number	:	1013161702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT HETLER RPH

Provider Business Mailing Address
First Line	:	3881 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-3633
Country	:	US
Telephone Number	:	334-271-5174
Fax Number	:	334-271-5724

Provider Business Practice Location Address
First Line	:	3881 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-3633
Country	:	US
Telephone Number	:	334-271-5174
Fax Number	:	334-271-5724

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2008
Last Update Date	:	11/08/2008

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