Provider Demographics
NPI:1609364553
Name:UECKER PHARMACIES INC
Entity Type:Organization
Organization Name:UECKER PHARMACIES INC
Other - Org Name:HERITAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:UECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-925-4510
Mailing Address - Street 1:609 S US HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:FREEMAN
Mailing Address - State:SD
Mailing Address - Zip Code:57029-2000
Mailing Address - Country:US
Mailing Address - Phone:605-925-4510
Mailing Address - Fax:605-925-7802
Practice Address - Street 1:609 S US HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:FREEMAN
Practice Address - State:SD
Practice Address - Zip Code:57029-2000
Practice Address - Country:US
Practice Address - Phone:605-925-4510
Practice Address - Fax:605-925-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SD100-18503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177184OtherPK
SD8502550Medicaid