Provider Demographics
NPI:1427566736
Name:HARDIN, JACQUELYNN TULL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:TULL
Last Name:HARDIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 WYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8136
Mailing Address - Country:US
Mailing Address - Phone:901-550-3554
Mailing Address - Fax:
Practice Address - Street 1:6727 RALEIGH LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7017
Practice Address - Country:US
Practice Address - Phone:901-498-5327
Practice Address - Fax:901-438-5338
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist