Provider Demographics
NPI:1265475800
Name:HEARTLAND PHARMACY, LLC
Entity Type:Organization
Organization Name:HEARTLAND PHARMACY, LLC
Other - Org Name:ACCUDOSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-331-0807
Mailing Address - Street 1:821 W SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5901
Mailing Address - Country:US
Mailing Address - Phone:417-877-1482
Mailing Address - Fax:417-877-1484
Practice Address - Street 1:821 W SUNSET ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5901
Practice Address - Country:US
Practice Address - Phone:417-877-1482
Practice Address - Fax:417-877-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO20040167783336L0003X
KS22-022813336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251919-00Medicaid
MO194336OtherBC/BS PROVIDER #
MO5656420001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER