MEDICARE: DR. DEREK TODD HEFFELFINGER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP444207	PA

General Provider Information

NPI Number	:	1144536491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK TODD HEFFELFINGER PHARMD

Provider Business Mailing Address
First Line	:	646 LIME ST
Second Line	:
City	:	PALMERTON
State	:	PA
Zip	:	18071-9771
Country	:	US
Telephone Number	:	484-695-3922
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-5505
Country	:	US
Telephone Number	:	215-467-0850
Fax Number	:	215-339-9807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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