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General NPI Number Information
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NPI Number | 1679063523
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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 | 05/16/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 5922B GEORGE WASHINGTON MEM HWY
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City | YORKTOWN
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State | VA
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Zip | 23692
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Country | US
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Telephone | 757-243-2764
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Fax |
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Provider Business Mailing Address
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Address Line | 5922B GEORGE WASHINGTON MEM HWY
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City | YORKTOWN
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State | VA
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Zip | 23692-2110
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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 | MANAGER
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Name | ERIC NELSEN
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Credential |
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Telephone | 757-243-2764
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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 | 201004843
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License Number State | VA
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