Provider Demographics
NPI:1568649507
Name:BRAINERD, HEIDI CHRISTINE (RPH, MS, BCPS)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:CHRISTINE
Last Name:BRAINERD
Suffix:
Gender:F
Credentials:RPH, MS, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 TUDOR CENTRE DRIVE, ROOM 103
Mailing Address - Street 2:RASU PHARMACY
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-729-4174
Mailing Address - Fax:907-729-8618
Practice Address - Street 1:4160 TUDOR CENTRE DRIVE
Practice Address - Street 2:ROOM 103, RASU PHARMACY
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5901
Practice Address - Country:US
Practice Address - Phone:907-729-4174
Practice Address - Fax:907-729-8618
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy