Provider Demographics
NPI:1083987838
Name:HEDER, MICHAEL FRANCIS (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:HEDER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 N BENTON DR
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-9447
Mailing Address - Country:US
Mailing Address - Phone:320-257-8326
Mailing Address - Fax:
Practice Address - Street 1:5540 N BENTON DR
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-9447
Practice Address - Country:US
Practice Address - Phone:320-257-8326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN118387OtherSTATE LICENSE NUMBER