Provider Demographics
NPI:1164733721
Name:HARBOR DRUG INC
Entity Type:Organization
Organization Name:HARBOR DRUG INC
Other - Org Name:HARBOR DRUG #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELPIERE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-315-8605
Mailing Address - Street 1:114 S HURON AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1201
Mailing Address - Country:US
Mailing Address - Phone:989-315-8605
Mailing Address - Fax:989-479-3242
Practice Address - Street 1:2046 BLACK RIVER ST STE 2
Practice Address - Street 2:
Practice Address - City:DECKERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48427-9448
Practice Address - Country:US
Practice Address - Phone:810-376-8070
Practice Address - Fax:810-376-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010094453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125651OtherPK
MI2374318Medicaid