Healthcare Provider Details

I. General information

NPI: 1558025213
Provider Name (Legal Business Name): HEATHER JUDIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 VIENNA AVE
NILES OH
44446-2622
US

IV. Provider business mailing address

101 KAPPA DR
PITTSBURGH PA
15238-2809
US

V. Phone/Fax

Practice location:
  • Phone: 330-652-2158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03127563
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: