Organization
DIELRX
Active
Other names
Heritage Pharmacy II
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT DIEL (OWNER)
(580) 233-4244
Entity
Organization
Contact information
Practice address
529 N MAIN ST, HENNESSEY, OK 73742-1033
(405) 853-7200
(405) 853-7209
Mailing address
529 N MAIN ST, HENNESSEY, OK 73742-1033
(405) 853-7200
(405) 853-7209
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54-7606
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200201750D
—
OK
01
—
2160668
PK
—
Enumeration date
07/07/2016
Last updated
05/12/2023
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