Provider Demographics
NPI:1538468244
Name:HEYDT, MELODY A
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:A
Last Name:HEYDT
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 1:420 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-9705
Mailing Address - Country:US
Mailing Address - Phone:610-589-4186
Mailing Address - Fax:
Practice Address - Street 1:420 N 3RD ST
Practice Address - Street 2:
Practice Address - City:WOMELSDORF
Practice Address - State:PA
Practice Address - Zip Code:19567-9705
Practice Address - Country:US
Practice Address - Phone:610-589-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034893L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist