Provider Demographics
NPI:1235417999
Name:WALCZYK, HEATHER LYNN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYNN
Last Name:WALCZYK
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 CATON AVE
Mailing Address - Street 2:APARTMENT #4C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2507
Mailing Address - Country:US
Mailing Address - Phone:716-698-4987
Mailing Address - Fax:
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1809
Practice Address - Country:US
Practice Address - Phone:716-698-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist