Provider Demographics
NPI:1740592591
Name:HARTIG DRUG CO CORP
Entity Type:Organization
Organization Name:HARTIG DRUG CO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARTIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, JD
Authorized Official - Phone:563-588-8700
Mailing Address - Street 1:703 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6814
Mailing Address - Country:US
Mailing Address - Phone:563-588-8700
Mailing Address - Fax:563-588-8750
Practice Address - Street 1:22 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-1630
Practice Address - Country:US
Practice Address - Phone:563-568-2628
Practice Address - Fax:563-568-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13763336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1740592591Medicaid
IA0243710020Medicare NSC