Provider Demographics
NPI:1528669371
Name:HARDWICK, TIMOTHY A
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:HARDWICK
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 1:3709 IMPERIAL DR E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-8133
Mailing Address - Country:US
Mailing Address - Phone:812-498-1330
Mailing Address - Fax:
Practice Address - Street 1:2500 PROGRESS PKWY
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8772
Practice Address - Country:US
Practice Address - Phone:317-392-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019192A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist