Provider Demographics
NPI:1225277098
Name:HEATH, AMY L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:HEATH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:HERRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:20 SOOJIANS DR
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524
Mailing Address - Country:US
Mailing Address - Phone:508-892-4058
Mailing Address - Fax:508-892-4073
Practice Address - Street 1:20 SOOJIANS DR
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524
Practice Address - Country:US
Practice Address - Phone:508-892-4058
Practice Address - Fax:508-892-4073
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist