Provider Demographics
NPI:1679195812
Name:MCKOWN, HEATHER MARIE (CPHT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:MCKOWN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:MORIAH
Mailing Address - State:NY
Mailing Address - Zip Code:12960-2308
Mailing Address - Country:US
Mailing Address - Phone:518-354-7081
Mailing Address - Fax:
Practice Address - Street 1:4315 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT HENRY
Practice Address - State:NY
Practice Address - Zip Code:12974-1339
Practice Address - Country:US
Practice Address - Phone:518-546-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30121829183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician