Provider Demographics
NPI:1407499098
Name:HARWARD, MARC STAFFORD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:STAFFORD
Last Name:HARWARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-1748
Mailing Address - Country:US
Mailing Address - Phone:385-377-7688
Mailing Address - Fax:
Practice Address - Street 1:555 S 200 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7249
Practice Address - Country:US
Practice Address - Phone:801-397-7833
Practice Address - Fax:801-397-7827
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150216-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist