Provider Demographics
NPI:1508963984
Name:POLEK, HEIDI A
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:POLEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MAPLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2848
Mailing Address - Country:US
Mailing Address - Phone:716-868-7118
Mailing Address - Fax:716-689-3471
Practice Address - Street 1:61 MAPLEVIEW DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-868-7118
Practice Address - Fax:716-689-3472
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039422-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist