Healthcare Provider Details

I. General information

NPI: 1396382164
Provider Name (Legal Business Name): DANA MARIE HEGLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 11/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21555 21 MILE RD
MACOMB MI
48044-2961
US

IV. Provider business mailing address

62711 MORNINGSIDE DR
WASHINGTON MI
48094-1325
US

V. Phone/Fax

Practice location:
  • Phone: 586-421-9877
  • Fax: 586-421-9886
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302036545
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: