Provider Demographics
NPI:1124008750
Name:EHARDTS ADVANCED CARE PHARMACY
Entity Type:Organization
Organization Name:EHARDTS ADVANCED CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-323-8280
Mailing Address - Street 1:50680 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3822
Mailing Address - Country:US
Mailing Address - Phone:586-323-8280
Mailing Address - Fax:586-323-8289
Practice Address - Street 1:5277 LAPEER RD SUITE B
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1422
Practice Address - Country:US
Practice Address - Phone:810-824-5110
Practice Address - Fax:810-824-5114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EHARDTS ADVANCED CARE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-19
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4764434Medicaid
MI540G411000OtherBCBS OF MICHIGAN
MI5480060001Medicare NSC