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General NPI Number Information
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NPI Number | 1831128552
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Entity Type | Organization
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Legal Business Name | NORTH HEIGHTS PHARMACY INC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 411 W 10TH ST NE
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City | ROME
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State | GA
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Zip | 30165-2640
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Country | US
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Telephone | 706-295-5712
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Fax | 706-295-3497
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Provider Business Mailing Address
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Address Line | 411 W 10TH ST NE
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City | ROME
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State | GA
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Zip | 30165-2640
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Country | US
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Telephone | 706-295-5712
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Fax | 706-295-3497
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. GRADY C TATE
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Credential | RPH
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Telephone | 706-295-5712
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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 | PHRE006126
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHRE006126
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License Number State | GA
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