Healthcare Provider Details

I. General information

NPI: 1851678866
Provider Name (Legal Business Name): JARED LEE HRDY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2011
Last Update Date: 11/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N BROADWELL AVE
GRAND ISLAND NE
68803-2153
US

IV. Provider business mailing address

16004 KISER RD
LOUISVILLE NE
68037-2814
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-3660
  • Fax:
Mailing address:
  • Phone: 402-690-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13715
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: