Provider Demographics
NPI:1336320423
Name:DAMOUR, HEATHER L (RPH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:DAMOUR
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 1:173 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1843
Mailing Address - Country:US
Mailing Address - Phone:518-891-6033
Mailing Address - Fax:
Practice Address - Street 1:173 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1843
Practice Address - Country:US
Practice Address - Phone:518-891-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049041OtherNEW YORK STATE LICENSE