Provider Demographics
NPI:1669555017
Name:HEIGHTS PRESCRIPTION PHARMACY, INC
Entity type:Organization
Organization Name:HEIGHTS PRESCRIPTION PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-842-1773
Mailing Address - Street 1:165 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-1334
Mailing Address - Country:US
Mailing Address - Phone:724-842-1773
Mailing Address - Fax:724-845-7897
Practice Address - Street 1:165 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-1334
Practice Address - Country:US
Practice Address - Phone:724-842-1773
Practice Address - Fax:724-845-7897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410769L332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3929859OtherNCPDP
PA1007627200005Medicaid
ND21544Medicaid
PA3929859OtherNCPDP