Healthcare Provider Details

I. General information

NPI: 1841502705
Provider Name (Legal Business Name): EHARDT'S PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 N LAPEER RD
NORTH BRANCH MI
48461-8150
US

IV. Provider business mailing address

57 N HOWARD AVE
CROSWELL MI
48422-1222
US

V. Phone/Fax

Practice location:
  • Phone: 810-793-5006
  • Fax:
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 Number5301009386
License Number StateMI

VIII. Authorized Official

Name: LARRY LIER II
Title or Position: CFO / BUSINESS MANAGER
Credential:
Phone: 810-679-2284