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NPI Code Detail

MEDICARE: HERITAGE PHARMACY INC

MEDICARE: HERITAGE 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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy020150150OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23633460OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1710954631
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE PHARMACY INC
Provider Business Mailing Address
First Line : 3675 DOLSON CT
Second Line :
City : CARROLL
State : OH
Zip : 43112-9721
Country : US
Telephone Number : 740-653-0942
Fax Number : 740-654-5041
Provider Business Practice Location Address
First Line : 3675 DOLSON CT
Second Line :
City : CARROLL
State : OH
Zip : 43112-9721
Country : US
Telephone Number : 740-653-0942
Fax Number : 740-654-5041
Authorized Official
Title or Position : SECRETARY
Name : JOHN HUNTER
Credential : RPH
Telephone Number : 740-653-0942
Provider Enumeration Date : 03/01/2006
Last Update Date : 01/18/2016

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Directions to “HERITAGE PHARMACY INC ” Practice Location

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