Provider Demographics
NPI:1700802030
Name:EHARDT'S PHARMACY INC.
Entity Type:Organization
Organization Name:EHARDT'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/ BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:810-679-2284
Mailing Address - Street 1:57 N HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1222
Mailing Address - Country:US
Mailing Address - Phone:810-679-2284
Mailing Address - Fax:
Practice Address - Street 1:4436 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BROWN CITY
Practice Address - State:MI
Practice Address - Zip Code:48416
Practice Address - Country:US
Practice Address - Phone:810-346-2637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010076023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P 38220Medicare PIN