Provider Demographics
NPI:1386828572
Name:HEARY, PATRICIA M (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:HEARY
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 1:12680 SCHUTT RD.
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:NY
Mailing Address - Zip Code:14134
Mailing Address - Country:US
Mailing Address - Phone:716-496-7400
Mailing Address - Fax:
Practice Address - Street 1:12208 RT. 16
Practice Address - Street 2:
Practice Address - City:YORKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:14173
Practice Address - Country:US
Practice Address - Phone:716-496-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046494-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01505926Medicaid