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NPI Code Detail

MEDICARE: MR. MARK HARTZFELD RPH

MEDICARE: MR. MARK HARTZFELD 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
1183500000XPharmacist11765NC

General Provider Information

NPI Number : 1699076943
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK HARTZFELD RPH
Provider Business Mailing Address
First Line : 2125 CLOVERDALE AVE
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-2506
Country : US
Telephone Number : 336-723-0561
Fax Number : 336-723-0882
Provider Business Practice Location Address
First Line : 2125 CLOVERDALE AVE
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-2506
Country : US
Telephone Number : 336-723-0561
Fax Number : 336-723-0882
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2010
Last Update Date : 11/03/2010

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