Healthcare Provider Details

I. General information

NPI: 1780274944
Provider Name (Legal Business Name): HEIDI HEFNER PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W HARDING RD
SPRINGFIELD OH
45504-1707
US

IV. Provider business mailing address

4885 HIGHLANDER LN
SPRINGFIELD OH
45502-8343
US

V. Phone/Fax

Practice location:
  • Phone: 937-244-0314
  • Fax:
Mailing address:
  • Phone: 937-390-6736
  • Fax: 937-390-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03322166
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: