Healthcare Provider Details

I. General information

NPI: 1780661751
Provider Name (Legal Business Name): HERITAGE PARK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE STE 154
WEST BURLINGTON IA
52655-1688
US

IV. Provider business mailing address

1225 S GEAR AVE STE 154
WEST BURLINGTON IA
52655-1688
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3960
  • Fax: 319-768-3964
Mailing address:
  • Phone: 319-768-3960
  • Fax: 319-768-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1060
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1060
License Number StateIA

VIII. Authorized Official

Name: JEREMY ALEXANDER
Title or Position: CEO
Credential:
Phone: 319-768-3280