Provider Demographics
NPI:1831128552
Name:NORTH HEIGHTS PHARMACY INC
Entity type:Organization
Organization Name:NORTH HEIGHTS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-295-5712
Mailing Address - Street 1:411 W 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2640
Mailing Address - Country:US
Mailing Address - Phone:706-295-5712
Mailing Address - Fax:706-295-3497
Practice Address - Street 1:411 W 10TH ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2640
Practice Address - Country:US
Practice Address - Phone:706-295-5712
Practice Address - Fax:706-295-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0061263336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1113454OtherNCPDP #
GA000032656AMedicaid
GA000032656AMedicaid