Provider Demographics
NPI:1730145624
Name:HARBOR DRUG INCORP
Entity Type:Organization
Organization Name:HARBOR DRUG INCORP
Other - Org Name:HARBOR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELPIERE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-315-8605
Mailing Address - Street 1:114 S HURON AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1201
Mailing Address - Country:US
Mailing Address - Phone:989-479-3242
Mailing Address - Fax:989-479-3242
Practice Address - Street 1:114 S HURON AVE
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1201
Practice Address - Country:US
Practice Address - Phone:989-479-3242
Practice Address - Fax:989-479-3242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR DRUG INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-21
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005688332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2827965Medicaid
MIOC20277OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
MIOC20277OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN