Heartland Pharmacy Lake Placid

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH26570 Issued in FL

Legal business name

HEARTLAND PHARMACY LAKE PLACID

Practice address

342 E Royal Palm St
Lake Placid, FL 33852-5019

Phone

(863) 659-1780

Fax

(863) 659-1786

NPI assigned

Dec 31, 2012

Organization subpart

No

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

Authorized official

Name

Carin Bralts, PHARMD

Title

Owner/President

Phone

(863) 449-1006

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Heartland Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

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

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1811233430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 E ROYAL PALM ST",
            "city": "LAKE PLACID",
            "state": "FL",
            "postal_code": "338525019",
            "telephone_number": "863-659-1780",
            "fax_number": "863-659-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 E ROYAL PALM ST",
            "city": "LAKE PLACID",
            "state": "FL",
            "postal_code": "338525019",
            "telephone_number": "863-659-1780",
            "fax_number": "863-659-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND PHARMACY LAKE PLACID",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-31",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "BRALTS",
        "authorized_official_first_name": "CARIN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "863-449-1006",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2138527",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008053900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• HC Medical and Cosmetic Products LLC
• Healthnomics LLC
• Heartland Medical Supply Inc
• Heartland Medical Supply Inc
• Heartland Pediatrics of Lake Placid, Inc.
• Heartland Pharmacy Lake Placid Inc
• Heartland Pharmacy Lake Placid Inc
• Michael James Henry, DO
• Gallardo De Grano Hermoso, PT
• Lydeliz Hernandez Perez

• Community/Retail Pharmacy in Lake Placid, FL
• Providers in Lake Placid, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.