Healthcare Provider Details

I. General information

NPI: 1427343987
Provider Name (Legal Business Name): AMMON JAMES HARDY PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP KADENA AIR BASE BUILDING 628 UNIT 5142
APO AP
96368-5142
US

IV. Provider business mailing address

18TH MEDICAL GROUP UNIT 5142 BOX 10
APO AP
96368-5142
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4598
  • Fax:
Mailing address:
  • Phone: 315-630-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20492
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: