Provider Demographics
NPI:1316044985
Name:HARTIG DRUG CO CORP
Entity Type:Organization
Organization Name:HARTIG DRUG CO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARTIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, JD
Authorized Official - Phone:563-588-8700
Mailing Address - Street 1:703 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6821
Mailing Address - Country:US
Mailing Address - Phone:563-588-8700
Mailing Address - Fax:563-588-8750
Practice Address - Street 1:1120 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809-1746
Practice Address - Country:US
Practice Address - Phone:608-822-3601
Practice Address - Fax:608-822-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8388-0423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33273900Medicaid
WI33273900Medicaid
WI0243710015Medicare NSC