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General NPI Number Information
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NPI Number | 1063958437
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Entity Type | Organization
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Legal Business Name | HEARTLAND PHARMACY LAKE PLACID INC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 342 E ROYAL PALM ST
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City | LAKE PLACID
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State | FL
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Zip | 33852-5019
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Country | US
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Telephone | 863-659-1780
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Fax | 863-659-1786
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Provider Business Mailing Address
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Address Line | 342 E ROYAL PALM ST
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City | LAKE PLACID
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State | FL
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Zip | 33852-5019
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Country | US
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Telephone | 863-659-1780
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Fax | 863-659-1786
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARIN DUNCAN BRALTS
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Credential | PHARMD
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Telephone | 863-449-1006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PH26570
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License Number State | FL
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