Provider Demographics
NPI:1780962126
Name:HEART OF AMERICA CLINIC PHARMACY INC.
Entity type:Organization
Organization Name:HEART OF AMERICA CLINIC PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-776-2531
Mailing Address - Street 1:2975 HIGHWAY 2 E # 101
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-7801
Mailing Address - Country:US
Mailing Address - Phone:701-776-2531
Mailing Address - Fax:701-776-6280
Practice Address - Street 1:2975 HIGHWAY 2 E # 101
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-7801
Practice Address - Country:US
Practice Address - Phone:701-776-2531
Practice Address - Fax:701-776-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3504760OtherNCPDP PROVIDER IDENTIFICATION NUMBER
ND1457472Medicaid