Provider Demographics
NPI:1235317629
Name:HEYWOOD, PAMELA MELISA (RPH)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MELISA
Last Name:HEYWOOD
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 1:20 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5033
Mailing Address - Country:US
Mailing Address - Phone:516-797-3036
Mailing Address - Fax:516-797-4256
Practice Address - Street 1:20 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5033
Practice Address - Country:US
Practice Address - Phone:516-797-3036
Practice Address - Fax:516-797-4256
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist