Healthcare Provider Details

I. General information

NPI: 1366208019
Provider Name (Legal Business Name): HEIGHTS PRESCRIPTION PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 LONGFELLOW ST STE 100
VANDERGRIFT PA
15690-1476
US

IV. Provider business mailing address

224 LONGFELLOW ST STE 100
VANDERGRIFT PA
15690-1476
US

V. Phone/Fax

Practice location:
  • Phone: 724-567-6615
  • Fax:
Mailing address:
  • Phone: 724-567-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007627200007
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: ALEXANDER J MICKLOW
Title or Position: CORPORATE SECTRETARY
Credential: R.PH.
Phone: 725-567-6615