Provider Demographics
NPI:1366441529
Name:HARDIN, PATRICE (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 SPRUCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-2803
Mailing Address - Country:US
Mailing Address - Phone:435-590-9465
Mailing Address - Fax:
Practice Address - Street 1:91 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2648
Practice Address - Country:US
Practice Address - Phone:435-586-9651
Practice Address - Fax:435-586-3473
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274313-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist