Healthcare Provider Details

I. General information

NPI: 1164230710
Provider Name (Legal Business Name): JOSH HEFFREN PHARMD, BCPPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

6106 ENQUIRER ST
HYATTSVILLE MD
20782-2982
US

V. Phone/Fax

Practice location:
  • Phone: 202-602-3000
  • Fax:
Mailing address:
  • Phone: 217-828-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License NumberPHA.0020054
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number8151219
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: