Active NPI
Hartsel Paul Frederick
- Pharmacist
- Cross Lanes, WV
National Provider Identifier
1912306994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP0003388
- Practice address
- 5054 Bennington Dr
Cross Lanes, WV 25313-2051 - Phone
- (304) 776-2789
- Fax
- (304) 776-0787
- NPI assigned
- Aug 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP0003388 | WV | Primary |
| Pharmacist | 183500000X | 03113560 | OH |
Addresses
Primary practice location
5054 Bennington Dr
Cross Lanes, WV 25313-2051
Mailing address
5054 Bennington Dr
Cross Lanes, WV 25313-2051
Phone (304) 776-2789
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03113560 | OH | MD | Pharmacist |
| RP0003388 | WV | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408060800000",
"number": "1912306994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5054 BENNINGTON DR",
"city": "CROSS LANES",
"state": "WV",
"postal_code": "253132051",
"telephone_number": "304-776-2789",
"fax_number": "304-776-0787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5054 BENNINGTON DR",
"city": "CROSS LANES",
"state": "WV",
"postal_code": "253132051",
"telephone_number": "304-776-2789",
"fax_number": "304-776-0787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "HARTSEL",
"middle_name": "PAUL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-15",
"last_updated": "2014-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0003388",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03113560",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cross Lanes, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.