Healthcare Provider Details

I. General information

NPI: 1689016321
Provider Name (Legal Business Name): CASSIE RAE HEFFERN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 N JEFFERSON AVE D106
SPRINGFIELD MO
65802-1917
US

IV. Provider business mailing address

1423 N JEFFERSON AVE D106
SPRINGFIELD MO
65802-1917
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-3808
  • Fax:
Mailing address:
  • Phone: 417-269-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2011031792
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: