Healthcare Provider Details

I. General information

NPI: 1316568645
Provider Name (Legal Business Name): EHARDT'S PHARMACY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 CAPAC RD STE 3
MUSSEY MI
48014-4306
US

IV. Provider business mailing address

57 N HOWARD AVE
CROSWELL MI
48422-1222
US

V. Phone/Fax

Practice location:
  • Phone: 810-310-8300
  • Fax: 810-310-8301
Mailing address:
  • Phone: 810-679-2284
  • Fax: 810-679-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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