Provider Demographics
NPI:1841380722
Name:HERITAGE, DARDEN
Entity Type:Individual
Prefix:
First Name:DARDEN
Middle Name:
Last Name:HERITAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 PRATT AVE NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3644
Mailing Address - Country:US
Mailing Address - Phone:256-534-1118
Mailing Address - Fax:256-534-1121
Practice Address - Street 1:704 PRATT AVE NE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3644
Practice Address - Country:US
Practice Address - Phone:256-534-1118
Practice Address - Fax:256-534-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist