Provider Demographics
NPI:1124658190
Name:HARTSELL, JOSHUA (PHARM D)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HARTSELL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4433
Mailing Address - Country:US
Mailing Address - Phone:770-832-9015
Mailing Address - Fax:
Practice Address - Street 1:1355 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4433
Practice Address - Country:US
Practice Address - Phone:770-832-9015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL190221835P0018X
GA0271851835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist