Provider Demographics
NPI:1831144575
Name:EHARDT'S ADVANCED CARE PHARMACY & MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:EHARDT'S ADVANCED CARE PHARMACY & MEDICAL SUPPLIES
Other - Org Name:EHARDT'S ADVANCED CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-323-8280
Mailing Address - Street 1:50680 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3107
Mailing Address - Country:US
Mailing Address - Phone:586-323-8280
Mailing Address - Fax:
Practice Address - Street 1:57 N HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1222
Practice Address - Country:US
Practice Address - Phone:810-679-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EHARDT'S ADVANCED CARE PHARMACY & MEDICAL SUPPLIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540G610210OtherBLUE CROSS AND BLUE SHIEL
MI4821540 87Medicaid
MI540G610210OtherBLUE CROSS AND BLUE SHIEL