Provider Demographics
NPI:1255643003
Name:HARDY, BRAYLON M (RPH)
Entity type:Individual
Prefix:DR
First Name:BRAYLON
Middle Name:M
Last Name:HARDY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13820 LORAIN AVE
Mailing Address - Street 2:GIANT EAGLE PHARMACY
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3428
Mailing Address - Country:US
Mailing Address - Phone:216-476-4731
Mailing Address - Fax:216-476-4737
Practice Address - Street 1:13820 LORAIN AVE
Practice Address - Street 2:GIANT EAGLE PHARMACY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3428
Practice Address - Country:US
Practice Address - Phone:216-476-4731
Practice Address - Fax:216-476-4737
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03129465183500000X
PARP443980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist