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General NPI Number Information
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NPI Number | 1669954681
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Entity Type | Organization
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Legal Business Name | HERITAGE PHARMACY
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 870 PARKWAY DRIVE
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City | SALYERSVILLE
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State | KY
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Zip | 41465
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Country | US
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Telephone | 502-592-2394
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 108
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City | SALYERSVILLE
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State | KY
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Zip | 41465-0108
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Country | US
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Telephone | 606-349-7733
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Fax | 606-349-7735
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Authorized Official
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Title or Position | OWNER/PIC
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Name | PAUL MICHAEL BURCHETT
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Credential | PHARMD
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Telephone | 502-592-2394
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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 | P08016
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License Number State | KY
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