Provider Demographics
NPI:1275896458
Name:HARTMAN, MICHELLE L (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 MARBURG AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-5012
Mailing Address - Country:US
Mailing Address - Phone:513-631-5717
Mailing Address - Fax:513-322-3138
Practice Address - Street 1:4825 MARBURG AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-5012
Practice Address - Country:US
Practice Address - Phone:513-631-5717
Practice Address - Fax:513-322-3138
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03321657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist