Provider Demographics
NPI:1669767141
Name:HARDY, JENNIFER L (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HARDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2436
Mailing Address - Country:US
Mailing Address - Phone:989-224-7075
Mailing Address - Fax:989-224-1606
Practice Address - Street 1:900 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2436
Practice Address - Country:US
Practice Address - Phone:989-224-7075
Practice Address - Fax:989-224-1606
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016818A183500000X
OH03218126183500000X
MI5302024743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist