Heritage Pharmacy Incorporated

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

23998 Issued in TX

Legal business name

HERITAGE PHARMACY INCORPORATED

Practice address

621 N. Hampton Rd
Ste. 108
Desoto, TX 75115

Phone

(469) 747-3171

Fax

(469) 747-3172

NPI assigned

Aug 18, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Naibon D. Moore

Title

Managing Officer

Phone

(313) 819-7339

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• HERITAGE PHARMACY Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marc Jones

  • Pharmacist
  • Desoto, TX
  • NPI 1164980280
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556064000000",
    "number": "1255445243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 N. HAMPTON RD",
            "address_2": "STE. 108",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "75115",
            "telephone_number": "469-747-3171",
            "fax_number": "469-747-3172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 N. HAMPTON RD",
            "address_2": "STE. 108",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "75115",
            "telephone_number": "469-747-3171",
            "fax_number": "469-747-3172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE PHARMACY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2019-04-24",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "NAIBON",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MANAGING OFFICER",
        "authorized_official_telephone_number": "313-819-7339",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "23998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145508",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2096860",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HERITAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HERITAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christina Henderson, BCBA
• Tenesha Henry, O.T.R.
• Franeshia Carol Henson
• Shirley Catherine Henson, RN
• Hephzibah Visiting Clinicians
• Heroic Love Inc
• Hickory Trail Hospital, L.P.
• Hickory Trail Hospital, L.P.
• Teira Hicks, DOULA, CASE MANAGMET
• High Baldy PLLC

• All providers in Desoto, TX
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; 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.