Provider Demographics
NPI:1710911052
Name:HARDIN, MICHAEL WADE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WADE
Last Name:HARDIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-4686
Mailing Address - Country:US
Mailing Address - Phone:865-882-2421
Mailing Address - Fax:865-882-2923
Practice Address - Street 1:319 N ROANE ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2022
Practice Address - Country:US
Practice Address - Phone:865-882-2421
Practice Address - Fax:865-882-2923
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist