=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477646818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN HARDY FAMILY ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2006
-----------------------------------------------------
Last Update Date | 04/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200A S 3RD STREET
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501-5447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-423-4333
-----------------------------------------------------
Fax | 918-429-0498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200A S 3RD STREET
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501-5447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-423-4333
-----------------------------------------------------
Fax | 918-429-0498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DPH
-----------------------------------------------------
Name | JOHN HARDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-423-4333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 15-6182
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------