Provider Demographics
NPI:1720595465
Name:HARDINGS MARKETS-WEST INC
Entity Type:Organization
Organization Name:HARDINGS MARKETS-WEST INC
Other - Org Name:HARDING'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:GUSTAVSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-685-9807
Mailing Address - Street 1:211 E BANNISTER ST STE E
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1372
Mailing Address - Country:US
Mailing Address - Phone:269-685-9807
Mailing Address - Fax:269-685-8536
Practice Address - Street 1:6430 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2016
Practice Address - Country:US
Practice Address - Phone:269-375-5369
Practice Address - Fax:269-372-8920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARDINGS MARKETS-WEST INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-03
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010113093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301011309OtherPHARMACY
MI5315089879OtherCONTROLLED SUBSTANCE