Healthcare Provider Details

I. General information

NPI: 1740323658
Provider Name (Legal Business Name): HEARTLAND MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 US 27 S
LAKE PLACID FL
33852-7900
US

IV. Provider business mailing address

6360 US 27 N
SEBRING FL
33870-1225
US

V. Phone/Fax

Practice location:
  • Phone: 863-699-6155
  • Fax: 863-465-9656
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH15581
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DUNCAN
Title or Position: OWNER AND PRESIDENT
Credential: RPH
Phone: 863-385-7673