NPIViewer - Provider NPI 1679943229

NPI:	1679943229
Name:	HERITAGE BIOLOGICS, LLC
Entity type:	Organization
Organization Name:	HERITAGE BIOLOGICS, LLC
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	SR. DIRECTOR OF QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:	BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:	KALEIKAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	816-875-5256
Mailing Address - Street 1:	255 NW VICTORIA DR STE B
Mailing Address - Street 2:
Mailing Address - City:	LEES SUMMIT
Mailing Address - State:	MO
Mailing Address - Zip Code:	64086-4709
Mailing Address - Country:	US
Mailing Address - Phone:	816-875-5101
Mailing Address - Fax:	844-402-3945
Practice Address - Street 1:	255 NW VICTORIA DR STE B
Practice Address - Street 2:
Practice Address - City:	LEES SUMMIT
Practice Address - State:	MO
Practice Address - Zip Code:	64086-4709
Practice Address - Country:	US
Practice Address - Phone:	855-937-7273
Practice Address - Fax:	844-402-3945
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2015-09-25
Last Update Date:	2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	251F00000X	Agencies	Home Infusion
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332BP3500X	Suppliers	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition
No	333600000X	Suppliers	Pharmacy
No	3336C0004X	Suppliers	Pharmacy	Compounding Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

State	Identifier ID	ID Type	Issuer
NH	3110366	Medicaid
VT	1030474	Medicaid
MI	1679943229	Medicaid
ID	1679943229	Medicaid
NY	5222688	Medicaid
TN	167943229	Medicaid
MT	1679943229	Medicaid
AR	1679943229	Medicaid
IA	1679943229	Medicaid
WA	2081347	Medicaid
LA	2205595	Medicaid
MD	300325600	Medicaid
KY	7100506060	Medicaid
OH	0229129	Medicaid
IL	1679943229	Medicaid
NM	1679943229	Medicaid
IN	1679943229	Medicaid
KS	201124950A	Medicaid
	2154209	Other	PK
NH	114015	Medicaid
NE	1679943229	Medicaid
OK	200661640A	Medicaid
SC	7M3667	Medicaid
AZ	1679943229	Medicaid
VA	1679943229	Medicaid
NJ	0589331	Medicaid
AK	1673661	Medicaid
UT	1679943229	Medicaid
MO	600026061	Medicaid
MO	1679943229	Medicaid
KS	201124950A	Medicaid