Basic Information
| Provider Information | |||||||||
| NPI: | 1598289167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTSELL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BRADFORD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2190 GILMER AVE | ||||||||
| Address2: | |||||||||
| City: | TALLASSEE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360787123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349913207 | ||||||||
| FaxNumber: | 3349913101 | ||||||||
| Practice Location | |||||||||
| Address1: | 2190 GILMER AVE | ||||||||
| Address2: | |||||||||
| City: | TALLASSEE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360787123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349913207 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 07/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 17717 | AL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.