Healthcare Provider Details

I. General information

NPI: 1518982818
Provider Name (Legal Business Name): EHARDTS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 HURON AVE
LEXINGTON MI
48450-8324
US

IV. Provider business mailing address

57 N HOWARD AVE
CROSWELL MI
48422-1222
US

V. Phone/Fax

Practice location:
  • Phone: 810-359-5322
  • Fax: 810-359-7200
Mailing address:
  • Phone: 810-679-2284
  • Fax: 810-679-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301002340
License Number StateMI

VIII. Authorized Official

Name: LARRY LIER
Title or Position: CFO
Credential:
Phone: 810-679-2284