Provider Demographics
NPI:1740255421
Name:HARDY, JENNIFER BOOTH (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BOOTH
Last Name:HARDY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1316 POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4222
Mailing Address - Country:US
Mailing Address - Phone:708-915-8453
Mailing Address - Fax:708-915-8579
Practice Address - Street 1:19550 GOVERNORS HIGHWAY
Practice Address - Street 2:SUITE 1100
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422
Practice Address - Country:US
Practice Address - Phone:708-915-8453
Practice Address - Fax:708-915-8579
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist