Provider Demographics
NPI:1073525127
Name:HERON, MELISSA THERESA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:THERESA
Last Name:HERON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 KENNEY LN
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-1422
Mailing Address - Country:US
Mailing Address - Phone:484-480-4914
Mailing Address - Fax:610-296-7127
Practice Address - Street 1:152 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1422
Practice Address - Country:US
Practice Address - Phone:610-296-5430
Practice Address - Fax:610-296-7127
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist