Healthcare Provider Details

I. General information

NPI: 1891071379
Provider Name (Legal Business Name): HEATHER MARIE SKOMROCK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE HODSON PHARMD

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E CENTRAL AVE
MIAMISBURG OH
45342-3546
US

IV. Provider business mailing address

1871 MELLOW DR
MIAMISBURG OH
45342-6751
US

V. Phone/Fax

Practice location:
  • Phone: 937-859-3879
  • Fax: 937-859-4013
Mailing address:
  • Phone: 513-267-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03227851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: