Healthcare Provider Details

I. General information

NPI: 1972160646
Provider Name (Legal Business Name): GORDON HARDY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 E 800 N
OREM UT
84097-4245
US

IV. Provider business mailing address

937 W MARCH BROWN DR
BLUFFDALE UT
84065-5626
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-4150
  • Fax:
Mailing address:
  • Phone: 801-609-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7223832-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: