Provider Demographics
NPI:1124537014
Name:HEARTLANDRXOK, LLC
Entity Type:Organization
Organization Name:HEARTLANDRXOK, LLC
Other - Org Name:HEARTLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-659-2784
Mailing Address - Street 1:501 W CARL HUBBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:OK
Mailing Address - Zip Code:74855-9119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:405-279-1058
Practice Address - Street 1:501 W CARL HUBBELL BLVD
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:OK
Practice Address - Zip Code:74855-9119
Practice Address - Country:US
Practice Address - Phone:405-279-1043
Practice Address - Fax:405-279-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-24
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31-80353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200732050AMedicaid