MEDICARE: DR. HEATHER LYNN MCINTOSH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202210342	VA

General Provider Information

NPI Number	:	1174815278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER LYNN MCINTOSH PHARMD

Provider Business Mailing Address
First Line	:	304 LONG CREEK LN
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-1923
Country	:	US
Telephone Number	:	703-586-8304
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 LONG CREEK LN
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-1923
Country	:	US
Telephone Number	:	703-586-8304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2011
Last Update Date	:	05/07/2011

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