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General NPI Number Information
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NPI Number | 1326291238
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Entity Type | Organization
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Legal Business Name | HERITAGE PHARMACY GATEWAY MALL INC
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 2700 STATE ST STE F13
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City | BISMARCK
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State | ND
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Zip | 58503-0669
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Country | US
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Telephone | 701-530-5800
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Fax | 701-530-5805
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Provider Business Mailing Address
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Address Line | 2700 STATE ST STE F13
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City | BISMARCK
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State | ND
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Zip | 58503-0669
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Country | US
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Telephone | 701-530-5800
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Fax | 701-530-5805
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Authorized Official
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Title or Position | OWNER
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Name | LUCAS HOECHST
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Credential | PHARMD
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Telephone | 701-530-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHAR779
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License Number State | ND
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