Provider Demographics
NPI:1548509615
Name:HERITAGE PHARMACY LLC
Entity type:Organization
Organization Name:HERITAGE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SATCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-368-6805
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-0896
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-1033
Practice Address - Country:US
Practice Address - Phone:405-375-6300
Practice Address - Fax:405-375-6340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy