MEDICARE: CHARLES JOHN HEPPNER

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	03112354	OH

General Provider Information

NPI Number	:	1619630092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES JOHN HEPPNER

Provider Business Mailing Address
First Line	:	6259 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-3217
Country	:	US
Telephone Number	:	440-449-3940
Fax Number	:

Provider Business Practice Location Address
First Line	:	6259 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-3217
Country	:	US
Telephone Number	:	440-449-3940
Fax Number	:

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

Provider Enumeration Date	:	10/21/2021
Last Update Date	:	10/29/2021

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