MEDICARE: MICHELLE HATHAWAY 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	03120642	OH

General Provider Information

NPI Number	:	1881129500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HATHAWAY RPH

Provider Business Mailing Address
First Line	:	1500 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2632
Country	:	US
Telephone Number	:	419-756-7023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2632
Country	:	US
Telephone Number	:	419-756-7023
Fax Number	:

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

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	05/01/2017

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Directions to “ MICHELLE HATHAWAY RPH” Practice Location

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