MEDICARE: HEARTLAND PHARMACY LAKE PLACID INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1306584156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND PHARMACY LAKE PLACID INC

Provider Business Mailing Address
First Line	:	342 E ROYAL PALM ST
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-5019
Country	:	US
Telephone Number	:	863-659-1780
Fax Number	:	863-659-1786

Provider Business Practice Location Address
First Line	:	342 E ROYAL PALM ST
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-5019
Country	:	US
Telephone Number	:	863-659-1780
Fax Number	:	863-659-1786

Authorized Official
Title or Position	:	OWNER, PHARMACIST
Name	:	CARIN D BRALTS
Credential	:
Telephone Number	:	863-659-1780

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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