Heartland Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1438 Issued in TN

Legal business name

HEARTLAND PHARMACY, LLC

Practice address

170 Beech St Ste 2
Harrogate, TN 37752-8514

Phone

(423) 869-7790

Fax

(423) 869-0702

NPI assigned

Jul 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Detra Lewis, PHARM D

Title

Mangr Co Ownr

Phone

(423) 869-7790

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• HEARTLAND PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491523200000",
    "number": "1033124672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 BEECH ST",
            "address_2": "SUITE 2",
            "city": "HARROGATE",
            "state": "TN",
            "postal_code": "377528251",
            "telephone_number": "423-869-7790",
            "fax_number": "423-869-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 BEECH ST STE 2",
            "city": "HARROGATE",
            "state": "TN",
            "postal_code": "377528514",
            "telephone_number": "423-869-7790",
            "fax_number": "423-869-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2017-04-07",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "DETRA",
        "authorized_official_title_or_position": "MANGR CO OWNR",
        "authorized_official_telephone_number": "423-869-7790",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "1438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033124672",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2090609",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100398550",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEARTLAND PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Harrogate Family & Health Care, Inc.
• Harrogate Family Practice
• Harrogate Health Group LLC
• Cierra Nicole Hatfield-Partin, PTA
• Hearland Medical P C
• Sarah Hedayati
• Trinidad Hernandez Jr., RN
• Tracie Herrell, FNP
• Randi Michelle Johnson, PA
• Alysse Jones

• All providers in Harrogate, TN
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.