Healthcare Provider Details

I. General information

NPI: 1528048725
Provider Name (Legal Business Name): MR. DAVID W. HARDY
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 6000 CAMP LESTER ATTN: PHARMACY DEPT
CHATAN-CHO, NAKAGAMI-GUN OKINAWA
9040103
JP

IV. Provider business mailing address

PSC 482 BOX 3044
FPO OKINAWA
AP
JP

V. Phone/Fax

Practice location:
  • Phone: 011816117437557
  • Fax:
Mailing address:
  • Phone: 011816117437276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH016856
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: