Healthcare Provider Details

I. General information

NPI: 1528011277
Provider Name (Legal Business Name): HEIDI CALVERT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E MAIN ST
MASCOUTAH IL
62258
US

IV. Provider business mailing address

1412 EILER RD
BELLEVILLE IL
62223
US

V. Phone/Fax

Practice location:
  • Phone: 618-566-8521
  • Fax: 618-566-8318
Mailing address:
  • Phone: 618-538-7204
  • Fax: 618-566-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: