Provider Demographics
NPI:1659572279
Name:HARDEE, JILLAINE G (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JILLAINE
Middle Name:G
Last Name:HARDEE
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 1:3076 BLACK JACK SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9127
Mailing Address - Country:US
Mailing Address - Phone:252-744-8320
Mailing Address - Fax:
Practice Address - Street 1:3076 BLACK JACK SIMPSON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-9127
Practice Address - Country:US
Practice Address - Phone:252-744-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist