Organization
HERITAGE PHARMACY INCORPORATED
Active
Other names
HERITAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NAIBON D. MOORE (MANAGING OFFICER)
(313) 819-7339
Entity
Organization
Contact information
Practice address
621 N. HAMPTON RD, STE. 108, DESOTO, TX 75115
(469) 747-3171
(469) 747-3172
Mailing address
621 N. HAMPTON RD, STE. 108, DESOTO, TX 75115
(469) 747-3171
(469) 747-3172
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
23998
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145508
—
TX
01
—
2096860
PK
—
Enumeration date
08/18/2006
Last updated
04/24/2019
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