=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780962126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART OF AMERICA CLINIC PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2011
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2975 HIGHWAY 2 E # 101
-----------------------------------------------------
City | RUGBY
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58368-7801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-776-2531
-----------------------------------------------------
Fax | 701-776-6280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2975 HIGHWAY 2 E # 101
-----------------------------------------------------
City | RUGBY
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58368-7801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-776-2531
-----------------------------------------------------
Fax | 701-776-6280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | TALLIE SCHNEIDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 701-776-2531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------