MEDICARE: BETH HECK

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	GA020613	GA

General Provider Information

NPI Number	:	1750830782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH HECK

Provider Business Mailing Address
First Line	:	3920 RICHMOND HILL CT
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-0415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 RICHMOND HILL CT
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-0415
Country	:	US
Telephone Number	:	770-887-9110
Fax Number	:

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

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	10/03/2016

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Directions to “ BETH HECK ” Practice Location

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