Provider Demographics
NPI:1366832149
Name:HASTREITER, SCOTT (RPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HASTREITER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 HOMETOWN DR
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-3301
Mailing Address - Country:US
Mailing Address - Phone:715-453-5996
Mailing Address - Fax:715-453-4508
Practice Address - Street 1:79 HOMETOWN DR
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-3301
Practice Address - Country:US
Practice Address - Phone:715-453-5996
Practice Address - Fax:715-453-4508
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14362-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist