Healthcare Provider Details

I. General information

NPI: 1215552385
Provider Name (Legal Business Name): EMILY LAUREN HEPLER RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 06/14/2020
Certification Date: 06/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S RIDGEWOOD AVE
DAYTONA BEACH FL
32114-4315
US

IV. Provider business mailing address

249 GULL DR S
DAYTONA BEACH FL
32119-1325
US

V. Phone/Fax

Practice location:
  • Phone: 386-767-3084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS50616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: