Provider Demographics
NPI:1699426015
Name:HARDIN, CLARREESA (PHARRM D)
Entity type:Individual
Prefix:DR
First Name:CLARREESA
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:PHARRM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19703 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-6830
Mailing Address - Country:US
Mailing Address - Phone:708-228-1691
Mailing Address - Fax:
Practice Address - Street 1:17550 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2001
Practice Address - Country:US
Practice Address - Phone:708-755-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist