Organization
HEARTLAND PHARMACY, LLC
Active
Other names
HEARTLAND PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DETRA LEWIS PHARM D (MANGR CO OWNR)
(423) 869-7790
Entity
Organization
Contact information
Practice address
170 BEECH ST STE 2, HARROGATE, TN 37752-8514
(423) 869-7790
(423) 869-0702
Mailing address
170 BEECH ST, SUITE 2, HARROGATE, TN 37752-8251
(423) 869-7790
(423) 869-0702
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1438
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033124672
—
TN
01
—
2090609
PK
—
05
—
7100398550
—
KY
Enumeration date
07/30/2006
Last updated
04/07/2017
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