Healthcare Provider Details

I. General information

NPI: 1548509615
Provider Name (Legal Business Name): HERITAGE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 N MAIN ST
HENNESSEY OK
73742-1033
US

IV. Provider business mailing address

PO BOX 896
KINGFISHER OK
73750-0896
US

V. Phone/Fax

Practice location:
  • Phone: 405-375-6300
  • Fax: 405-375-6340
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DENNIS SATCHELL
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 405-368-6805