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General NPI Number Information
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NPI Number | 1548509615
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Entity Type | Organization
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Legal Business Name | HERITAGE PHARMACY LLC
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 529 N MAIN ST
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City | HENNESSEY
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State | OK
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Zip | 73742-1033
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Country | US
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Telephone | 405-375-6300
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Fax | 405-375-6340
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Provider Business Mailing Address
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Address Line | PO BOX 896
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City | KINGFISHER
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State | OK
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Zip | 73750-0896
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DENNIS SATCHELL
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Credential |
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Telephone | 405-368-6805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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