Healthcare Provider Details

I. General information

NPI: 1477955888
Provider Name (Legal Business Name): HEARTLAND FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 SUGAR MAPLE DR SUITE A
AUBURN KY
42206
US

IV. Provider business mailing address

PO BOX 467
AUBURN KY
42206-0467
US

V. Phone/Fax

Practice location:
  • Phone: 270-847-4004
  • Fax: 270-847-4005
Mailing address:
  • Phone: 270-847-4004
  • Fax: 270-847-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07649
License Number StateKY

VIII. Authorized Official

Name: SCOTT YATES
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 270-725-7504