Provider Demographics
NPI:1942863543
Name:HARTSELL, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HARTSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-3447
Mailing Address - Country:US
Mailing Address - Phone:580-276-5555
Mailing Address - Fax:
Practice Address - Street 1:300 S HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448-3447
Practice Address - Country:US
Practice Address - Phone:580-276-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist