MEDICARE: KENNETH HARDWICK

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	3715	SC

General Provider Information

NPI Number	:	1558814905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH HARDWICK

Provider Business Mailing Address
First Line	:	10B WINCHESTER CT
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2627
Country	:	US
Telephone Number	:	864-288-0911
Fax Number	:	864-297-0159

Provider Business Practice Location Address
First Line	:	10B WINCHESTER CT
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2627
Country	:	US
Telephone Number	:	864-288-0911
Fax Number	:	864-297-0159

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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Directions to “ KENNETH HARDWICK ” Practice Location

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