Provider Demographics
NPI:1689967044
Name:HARTKOPF, ERIC (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HARTKOPF
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3392
Mailing Address - Country:US
Mailing Address - Phone:608-873-1342
Mailing Address - Fax:608-873-4009
Practice Address - Street 1:160 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3392
Practice Address - Country:US
Practice Address - Phone:608-873-1342
Practice Address - Fax:608-873-4009
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist