Provider Demographics
NPI:1225526379
Name:HARDIMAN, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:HARDIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:RAMPICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 HOLLY TREE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-3120
Mailing Address - Country:US
Mailing Address - Phone:774-400-2343
Mailing Address - Fax:
Practice Address - Street 1:438 W GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1459
Practice Address - Country:US
Practice Address - Phone:508-946-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist