Healthcare Provider Details

I. General information

NPI: 1295263028
Provider Name (Legal Business Name): LEAH HEFFERNAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N STATE ST STE 1500
SAINT IGNACE MI
49781-1048
US

IV. Provider business mailing address

1140 N STATE ST STE 1500
SAINT IGNACE MI
49781-1048
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-7298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038905
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: