Provider Demographics
NPI:1851634109
Name:HARTFORD PHARMACY LLC
Entity Type:Organization
Organization Name:HARTFORD PHARMACY LLC
Other - Org Name:DALTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-797-7992
Mailing Address - Street 1:112 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36344-1615
Mailing Address - Country:US
Mailing Address - Phone:334-588-2442
Mailing Address - Fax:334-588-2447
Practice Address - Street 1:112 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:AL
Practice Address - Zip Code:36344-1615
Practice Address - Country:US
Practice Address - Phone:334-588-2442
Practice Address - Fax:334-588-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1140773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139751OtherPK
AL148150Medicaid