Provider Demographics
NPI:1518982818
Name:EHARDTS PHARMACY INC
Entity Type:Organization
Organization Name:EHARDTS PHARMACY INC
Other - Org Name:EHARDTS PHARMACY INC #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:7275 HURON AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-8324
Practice Address - Country:US
Practice Address - Phone:810-359-5322
Practice Address - Fax:810-359-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010023403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043084OtherPK
MI2509165Medicaid
2043084OtherPK
1059070001Medicare NSC