Provider Demographics
NPI:1366757379
Name:HARWARD, MARK (PHARMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HARWARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N CENTRAL ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86021-6134
Mailing Address - Country:US
Mailing Address - Phone:928-813-7110
Mailing Address - Fax:928-813-7120
Practice Address - Street 1:80 N CENTRAL ST UNIT 6
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:AZ
Practice Address - Zip Code:86021-6134
Practice Address - Country:US
Practice Address - Phone:928-813-7110
Practice Address - Fax:928-813-7120
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6343157-1701183500000X
AZS024579183500000X
TX67608183500000X
FLPS46705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist