Provider Demographics
NPI:1073753281
Name:HERITAGE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:HERITAGE PHARMACY SERVICES INC
Other - Org Name:HERITAGE PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-981-7340
Mailing Address - Street 1:21674 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7905
Mailing Address - Country:US
Mailing Address - Phone:248-416-1310
Mailing Address - Fax:248-416-1316
Practice Address - Street 1:21674 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7905
Practice Address - Country:US
Practice Address - Phone:248-416-1310
Practice Address - Fax:248-416-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010090653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119401OtherPK