Provider Demographics
NPI:1518266147
Name:HART, MICHAEL G
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:HART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NEWPORT PLAZA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074
Mailing Address - Country:US
Mailing Address - Phone:717-567-6670
Mailing Address - Fax:717-567-6981
Practice Address - Street 1:10 NEWPORT PLAZA
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074
Practice Address - Country:US
Practice Address - Phone:717-567-6670
Practice Address - Fax:717-567-6981
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22114736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist