Organization
HERITAGE PARK PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL MARIE DESJARDINS (OWNER)
(405) 737-6697
Entity
Organization
Contact information
Practice address
6908 E RENO AVE STE 101, MIDWEST CITY, OK 73110-2120
(405) 737-6697
(405) 737-6698
Mailing address
6908 E RENO AVE STE 101, MIDWEST CITY, OK 73110-2120
(405) 737-6697
(405) 737-6698
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
T-6052
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237240A
—
OK
01
—
3713218
NCPDP
OK
Enumeration date
04/20/2007
Last updated
01/30/2014
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