=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548673593
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. HEATHER MIALKI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2014
-----------------------------------------------------
Last Update Date | 06/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 MOUNTAIN RD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21122-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-360-1509
-----------------------------------------------------
Fax | 410-360-4209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 MOUNTAIN RD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21122-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-360-1509
-----------------------------------------------------
Fax | 410-360-4209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 21931
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------