Healthcare Provider Details

I. General information

NPI: 1467564476
Provider Name (Legal Business Name): HERITAGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 DOLSON CT
CARROLL OH
43112-9721
US

IV. Provider business mailing address

3675 DOLSON CT
CARROLL OH
43112-9721
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-0942
  • Fax: 740-653-7372
Mailing address:
  • Phone: 740-653-0942
  • Fax: 740-653-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number021090450
License Number StateOH

VIII. Authorized Official

Name: SHELLEY HUNTER
Title or Position: PRESIDENT
Credential:
Phone: 740-653-0942