Provider Demographics
NPI:1649585696
Name:HARDESTY, DRUCILLA A (RPH)
Entity Type:Individual
Prefix:
First Name:DRUCILLA
Middle Name:A
Last Name:HARDESTY
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 1:2636 RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7326
Mailing Address - Country:US
Mailing Address - Phone:337-433-4178
Mailing Address - Fax:337-433-3961
Practice Address - Street 1:2636 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7326
Practice Address - Country:US
Practice Address - Phone:337-433-4178
Practice Address - Fax:337-433-3961
Is Sole Proprietor?:No
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist