Provider Demographics
NPI:1467128009
Name:HARTWIG, SANDRA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:RUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:565 120TH ST
Mailing Address - Street 2:
Mailing Address - City:KANAWHA
Mailing Address - State:IA
Mailing Address - Zip Code:50447
Mailing Address - Country:US
Mailing Address - Phone:641-860-0436
Mailing Address - Fax:641-843-4197
Practice Address - Street 1:52 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:BRITT
Practice Address - State:IA
Practice Address - Zip Code:50423
Practice Address - Country:US
Practice Address - Phone:641-843-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12603183500000X
IA17751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist