Provider Demographics
NPI:1104412113
Name:HARDY, COURTNEY ADAM (PHARMD)
Entity type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:ADAM
Last Name:HARDY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:COURT
Other - Middle Name:
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634-0789
Mailing Address - Country:US
Mailing Address - Phone:435-528-3455
Mailing Address - Fax:435-528-3776
Practice Address - Street 1:77 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634-7706
Practice Address - Country:US
Practice Address - Phone:435-528-3455
Practice Address - Fax:435-528-3776
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6729835-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist