Provider Demographics
NPI:1710081849
Name:HARDINGS PHARMACY
Entity Type:Organization
Organization Name:HARDINGS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTAVSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-492-2919
Mailing Address - Street 1:5165 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1003
Mailing Address - Country:US
Mailing Address - Phone:269-381-0270
Mailing Address - Fax:269-381-9415
Practice Address - Street 1:5165 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1003
Practice Address - Country:US
Practice Address - Phone:269-381-0270
Practice Address - Fax:269-381-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2355596Medicaid
MI2355596Medicaid