Provider Demographics
NPI:1942051891
Name:HARDAWAY, R. A II
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:A
Last Name:HARDAWAY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:HARDAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:24385 WILDERNESS OAK APT 8307
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7765
Mailing Address - Country:US
Mailing Address - Phone:210-663-7857
Mailing Address - Fax:
Practice Address - Street 1:1836 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3437
Practice Address - Country:US
Practice Address - Phone:210-658-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist