MEDICARE: EHARDTS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301002340	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2043084	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518982818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EHARDTS PHARMACY INC

Provider Business Mailing Address
First Line	:	57 N HOWARD AVE
Second Line	:
City	:	CROSWELL
State	:	MI
Zip	:	48422-1222
Country	:	US
Telephone Number	:	810-679-2284
Fax Number	:	810-679-2364

Provider Business Practice Location Address
First Line	:	7275 HURON AVE
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-8324
Country	:	US
Telephone Number	:	810-359-5322
Fax Number	:	810-359-7200

Authorized Official
Title or Position	:	CFO
Name	:	LARRY LIER
Credential	:
Telephone Number	:	810-679-2284

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/30/2021

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Directions to “EHARDTS PHARMACY INC ” Practice Location

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