Healthcare Provider Details

I. General information

NPI: 1780775700
Provider Name (Legal Business Name): HERITAGE PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 KNOLLWOOD DR
MOBILE AL
36693-2753
US

IV. Provider business mailing address

6207 COTTAGE HILL RD SUITE G
MOBILE AL
36609-3113
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-7600
  • Fax: 251-602-9160
Mailing address:
  • Phone: 251-666-0250
  • Fax: 251-660-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number200374
License Number StateAL

VIII. Authorized Official

Name: HENRY B FULGHAM
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 251-343-9600