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General NPI Number Information
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NPI Number | 1780316141
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Entity Type | Individual
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Provider Name | JONATHAN WAYNE HARDAGE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2022
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Last Update Date | 06/25/2022
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Provider Practice Location Address
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Address Line | 3604 N HIGHWAY 7
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City | HOT SPRINGS VILLAGE
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State | AR
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Zip | 71909-9607
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Country | US
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Telephone | 501-318-0185
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Fax |
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Provider Business Mailing Address
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Address Line | 2268 HIGHWAY 128
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City | BISMARCK
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State | AR
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Zip | 71929-6595
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD16188
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License Number State | AR
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