Provider Demographics
NPI:1467996801
Name:HEARTLAND PHARMACY CORP
Entity Type:Organization
Organization Name:HEARTLAND PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-285-9940
Mailing Address - Street 1:17827 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4624
Mailing Address - Country:US
Mailing Address - Phone:718-285-9940
Mailing Address - Fax:718-819-1144
Practice Address - Street 1:17827 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4624
Practice Address - Country:US
Practice Address - Phone:718-285-9940
Practice Address - Fax:718-819-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-04
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy