Heritage Park Pharmacy, LLC

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

T-6052 Issued in OK

Legal business name

HERITAGE PARK PHARMACY, LLC

Practice address

6908 E Reno Ave Ste 101
Midwest City, OK 73110-2120

Phone

(405) 737-6697

Fax

(405) 737-6698

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Cheryl Marie Desjardins

Title

Owner

Phone

(405) 737-6697

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1619194453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6908 E RENO AVE STE 101",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731102120",
            "telephone_number": "405-737-6697",
            "fax_number": "405-737-6698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6908 E RENO AVE STE 101",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731102120",
            "telephone_number": "405-737-6697",
            "fax_number": "405-737-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE PARK PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "DESJARDINS",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-737-6697"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacy Technician",
            "state": "OK",
            "license": "T-6052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100237240A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3713218",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heritage Park Eye Care Center (Vision Source Midwest City)
• Heritage Park Eye Care Center (Vision Source Midwest City)
• Heritage Park Eye Care Center (Vision Source Midwest City)
• Heritage Park Eye Care Center (Vision Source Midwest City)
• Heritage Park Medical Center Inc
• Heritage Park Vision Source (Vision Source Midwest City)
• Faith Hernandez
• Hero Vision of Midwest City PLLC (Adventure Dental and Vision)
• Rachel Marie Herrera, OTA
• Asia Janae Herrod

• Pharmacy Technician in Midwest City, OK
• Providers in Midwest City, OK by specialty
• Pharmacy Technician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; 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.