Provider Demographics
NPI:1083222731
Name:HARTMAN, BRIAN CHARLES
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHARLES
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 WALZEM RD
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2107
Mailing Address - Country:US
Mailing Address - Phone:210-657-7071
Mailing Address - Fax:210-657-0853
Practice Address - Street 1:5760 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2107
Practice Address - Country:US
Practice Address - Phone:210-657-7071
Practice Address - Fax:210-657-0853
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist