Healthcare Provider Details

I. General information

NPI: 1144305319
Provider Name (Legal Business Name): CHARLES RICHARD HARDAMON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 MAIN AVE
AKRON CO
80720-1439
US

IV. Provider business mailing address

93 MAIN AVE
AKRON CO
80720-1439
US

V. Phone/Fax

Practice location:
  • Phone: 970-345-6828
  • Fax: 970-345-0769
Mailing address:
  • Phone: 970-345-6828
  • Fax: 970-345-0769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9769
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: