Provider Demographics
NPI:1528048725
Name:HARDY, DAVID W
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:HARDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482 BOX 3044
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:AP
Mailing Address - Country:JP
Mailing Address - Phone:01181611-743-7276
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 6000 CAMP LESTER
Practice Address - Street 2:ATTN: PHARMACY DEPT
Practice Address - City:CHATAN-CHO, NAKAGAMI-GUN
Practice Address - State:OKINAWA
Practice Address - Zip Code:9040103
Practice Address - Country:JP
Practice Address - Phone:01181611-743-7557
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH016856Medicare UPIN