Healthcare Provider Details

I. General information

NPI: 1427450097
Provider Name (Legal Business Name): HEIDI FLETCHER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43471 STATE HIGHWAY 299 E
FALL RIVER MILLS CA
96028-9777
US

IV. Provider business mailing address

43471 STATE HIGHWAY 299 E
FALL RIVER MILLS CA
96028-9777
US

V. Phone/Fax

Practice location:
  • Phone: 530-336-5511
  • Fax:
Mailing address:
  • Phone: 530-336-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: