MEDICARE: JOE E HEIDRICK PHARM D

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	17329	NC

General Provider Information

NPI Number	:	1619964632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE E HEIDRICK PHARM D

Provider Business Mailing Address
First Line	:	9 WATER GARDEN WAY
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 S ESTES DR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-7001
Country	:	US
Telephone Number	:	919-918-7595
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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