Healthcare Provider Details

I. General information

NPI: 1831304310
Provider Name (Legal Business Name): MARK JAMES HARDY PHARM D CANDIDATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST 3RD AVE S
CAVALIER ND
58220-0000
US

IV. Provider business mailing address

418 MAIN ST.
NECHE ND
58265-0006
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-4744
  • Fax:
Mailing address:
  • Phone: 701-886-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1037
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: