Provider Demographics
NPI:1033419940
Name:HEASTER, MARY E (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:HEASTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 OLD STEESE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3138
Mailing Address - Country:US
Mailing Address - Phone:907-459-4233
Mailing Address - Fax:907-459-4227
Practice Address - Street 1:930 OLD STEESE HWY
Practice Address - Street 2:PHARMACY
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3138
Practice Address - Country:US
Practice Address - Phone:907-459-4233
Practice Address - Fax:907-459-4227
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist