Provider Demographics
NPI:1235807892
Name:EHARDT'S PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:EHARDT'S PHARMACY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:810-679-2284
Mailing Address - Street 1:57 N HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1222
Mailing Address - Country:US
Mailing Address - Phone:810-679-2284
Mailing Address - Fax:
Practice Address - Street 1:4545 VAN DYKE RD STE A
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003-8511
Practice Address - Country:US
Practice Address - Phone:810-679-2284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy