Provider Demographics
NPI:1245389949
Name:HARDING ROAD PHARMACY, INC.
Entity Type:Organization
Organization Name:HARDING ROAD PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-399-8531
Mailing Address - Street 1:400 W HARDING RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1707
Mailing Address - Country:US
Mailing Address - Phone:937-399-8531
Mailing Address - Fax:937-399-4911
Practice Address - Street 1:400 W HARDING RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1707
Practice Address - Country:US
Practice Address - Phone:937-399-8531
Practice Address - Fax:937-399-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH069470001332B00000X
OH02-01819503336C0003X
OH0201819503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0478273Medicaid
OH0478273Medicaid