Individual
JESSICA HARDAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1910 MARTIN LUTHER KING BLVD, MALVERN, AR 72104-2203
(501) 337-1170
Mailing address
2202 HIGHWAY 128, BISMARCK, AR 71929-6595
(870) 313-1406
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PI22654
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PI22654
PHARMACY INTERN LICENSE
AR
Enumeration date
04/28/2021
Last updated
04/28/2021
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