Healthcare Provider Details

I. General information

NPI: 1710273446
Provider Name (Legal Business Name): HEIDI MICHELLE HRENO-WALTER R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 BOARDMAN POLAND RD
BOARDMAN OH
44512-4907
US

IV. Provider business mailing address

417 BOARDMAN POLAND RD
BOARDMAN OH
44512-4907
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-5930
  • Fax: 330-758-5930
Mailing address:
  • Phone: 330-758-5930
  • Fax: 330-758-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03221502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: