Healthcare Provider Details

I. General information

NPI: 1720291248
Provider Name (Legal Business Name): MELANIE ELIZABETH HEITMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 GULF OF MEXICO DR STE 101
LONGBOAT KEY FL
34228-2048
US

IV. Provider business mailing address

4140 LINWOOD ST
SARASOTA FL
34232-3808
US

V. Phone/Fax

Practice location:
  • Phone: 941-426-2800
  • Fax: 941-423-6368
Mailing address:
  • Phone: 941-266-7610
  • Fax: 941-423-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: