MEDICARE: DR. BRAYLON M HARDY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH.03129465	OH
2	183500000X	Pharmacist	RP443980	PA

General Provider Information

NPI Number	:	1255643003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAYLON M HARDY RPH

Provider Business Mailing Address
First Line	:	13820 LORAIN AVE
Second Line	:	GIANT EAGLE PHARMACY
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3428
Country	:	US
Telephone Number	:	216-476-4731
Fax Number	:	216-476-4737

Provider Business Practice Location Address
First Line	:	13820 LORAIN AVE
Second Line	:	GIANT EAGLE PHARMACY
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3428
Country	:	US
Telephone Number	:	216-476-4731
Fax Number	:	216-476-4737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	07/09/2010

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