MEDICARE: MRS. REBECCA LYNN HEFELE R.PH.

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	042660	MO

General Provider Information

NPI Number	:	1790088185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA LYNN HEFELE R.PH.

Provider Business Mailing Address
First Line	:	1227 WOODRIDGE TRAILS DR
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-2325
Country	:	US
Telephone Number	:	636-343-6599
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 WEDGEWAY CT
Second Line	:
City	:	EARTH CITY
State	:	MO
Zip	:	63045-1213
Country	:	US
Telephone Number	:	314-291-1122
Fax Number	:	314-291-1133

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

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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