Provider Demographics
NPI:1679198212
Name:HARDKE, RACHEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HARDKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:NULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14984 HIGHWAY 86 W
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:AR
Mailing Address - Zip Code:72064-8348
Mailing Address - Country:US
Mailing Address - Phone:479-650-0723
Mailing Address - Fax:
Practice Address - Street 1:14984 HIGHWAY 86 W
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:AR
Practice Address - Zip Code:72064-8348
Practice Address - Country:US
Practice Address - Phone:479-650-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12277333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy