Provider Demographics
NPI:1841373602
Name:JOY M. BERNHARDT DBA HERITAGE HILLS DISCOUNT PHARMACY
Entity type:Organization
Organization Name:JOY M. BERNHARDT DBA HERITAGE HILLS DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-564-2227
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:709 HIGHWAY 70 EAST, STE. B
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-0310
Mailing Address - Country:US
Mailing Address - Phone:580-564-2227
Mailing Address - Fax:580-564-4844
Practice Address - Street 1:709 HIGHWAY 70 EAST, STE. B
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-0282
Practice Address - Country:US
Practice Address - Phone:580-564-2227
Practice Address - Fax:580-564-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100237280BMedicaid
OK0312830001Medicare NSC