Provider Demographics
NPI:1932709672
Name:HARTMAN, GAIL GRACI (RPH)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:GRACI
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SHAGBARK TRL
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-7208
Mailing Address - Country:US
Mailing Address - Phone:706-536-0334
Mailing Address - Fax:
Practice Address - Street 1:5448 WHITTLESEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7298
Practice Address - Country:US
Practice Address - Phone:706-649-6322
Practice Address - Fax:706-649-6322
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist