Provider Demographics
NPI:1871671008
Name:HARBOR DRUG INC
Entity Type:Organization
Organization Name:HARBOR DRUG INC
Other - Org Name:HARBOR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAYL
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:989-315-8605
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:989-315-8605
Practice Address - Fax:989-479-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005688333600000X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2349719OtherNABP
MI2827956Medicaid
MI2349719OtherBLUE CROSS
MI2827956Medicaid
MI0C20277Medicare PIN