Provider Demographics
NPI:1235732843
Name:YIALIADES, HEIDI M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:YIALIADES
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 1:456 S BARRE RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-8107
Mailing Address - Country:US
Mailing Address - Phone:802-479-0432
Mailing Address - Fax:
Practice Address - Street 1:456 S BARRE RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-8107
Practice Address - Country:US
Practice Address - Phone:802-479-0432
Practice Address - Fax:802-479-2367
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0003414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist