Healthcare Provider Details

I. General information

NPI: 1619705035
Provider Name (Legal Business Name): JORDAN ALEXANDER HARDRICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E BROADWAY ST
HELENA MT
59601-4905
US

IV. Provider business mailing address

934 MISSOULA AVE
HELENA MT
59601-3847
US

V. Phone/Fax

Practice location:
  • Phone: 406-447-2547
  • Fax:
Mailing address:
  • Phone: 937-367-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-107634
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: