Provider Demographics
NPI:1508149444
Name:HARTSELL, FALLON ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FALLON
Middle Name:ANNE
Last Name:HARTSELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 FALLING LEAF LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-7816
Mailing Address - Country:US
Mailing Address - Phone:334-444-4044
Mailing Address - Fax:
Practice Address - Street 1:5707 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9003
Practice Address - Country:US
Practice Address - Phone:706-322-6253
Practice Address - Fax:706-322-8995
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025012183500000X
AL15959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist