Provider Demographics
NPI:1417157363
Name:HARTMAN, HUGH A JR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:A
Last Name:HARTMAN
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BONYTHON AVE
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1819
Mailing Address - Country:US
Mailing Address - Phone:207-809-5358
Mailing Address - Fax:
Practice Address - Street 1:27 N PERLEY BROOK RD
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1925
Practice Address - Country:US
Practice Address - Phone:207-809-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPR3231OtherCERTIFIED IN ADMIN OF DRUGS & IMMUNIZATIONS