Healthcare Provider Details

I. General information

NPI: 1922510817
Provider Name (Legal Business Name): BRADLEY T HEFFRON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 HENDERSON RD
UPPER ARLINGTON OH
43220-2401
US

IV. Provider business mailing address

5227 LINWORTH RD
COLUMBUS OH
43235-3426
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-1939
  • Fax: 614-457-1958
Mailing address:
  • Phone: 614-753-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-28026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: