Provider Demographics
NPI:1013359421
Name:HERITAGE THERAPEUTICS LLC
Entity Type:Organization
Organization Name:HERITAGE THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RAFFAELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-343-2136
Mailing Address - Street 1:2173 MACDADE BLVD
Mailing Address - Street 2:UNIT C & D
Mailing Address - City:HOLMES
Mailing Address - State:PA
Mailing Address - Zip Code:19043-1217
Mailing Address - Country:US
Mailing Address - Phone:855-343-2136
Mailing Address - Fax:
Practice Address - Street 1:2173 MACDADE BLVD
Practice Address - Street 2:UNIT C & D
Practice Address - City:HOLMES
Practice Address - State:PA
Practice Address - Zip Code:19043-1217
Practice Address - Country:US
Practice Address - Phone:855-343-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PAPP4824053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies