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Contact Information

HERITAGE PHARMACY INCORPORATED
621 N. HAMPTON RD
STE. 108
DESOTO, TX75115
 Phone: 469-747-3171
 Fax: 469-747-3172
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for HERITAGE PHARMACY INCORPORATED

NPI Number 1255445243
LBN Legal business name HERITAGE PHARMACY INCORPORATED
Authorized official NAIBON MOORE - (MANAGING OFFICER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/18/2006
Last updated 04/24/2019 - About 7 years ago
Identifiers
TX License # 23998
TX Medicaid 145508
Other 2096860 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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