Organization
HERITAGE PHARMACY GATEWAY MALL INC
Active
Other names
Heritage Pharmacy Gateway Mall Inc
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS HOECHST PHARMD (OWNER)
(701) 530-5800
Entity
Organization
Contact information
Practice address
2700 STATE ST, STE F13, BISMARCK, ND 58503-0669
(701) 530-5800
(701) 530-5805
Mailing address
2700 STATE ST, STE F13, BISMARCK, ND 58503-0669
(701) 530-5800
(701) 530-5805
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR779
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1455717
—
ND
01
—
2118069
PK
—
Enumeration date
10/23/2008
Last updated
04/19/2017
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