Provider Demographics
NPI:1316568645
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:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIER
Authorized Official - Suffix:
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:810-679-2364
Practice Address - Street 1:3433 CAPAC RD STE 3
Practice Address - Street 2:
Practice Address - City:MUSSEY
Practice Address - State:MI
Practice Address - Zip Code:48014-4306
Practice Address - Country:US
Practice Address - Phone:810-310-8300
Practice Address - Fax:810-310-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy