Provider Demographics
NPI:1891325460
Name:MAWN, HEATHER CHRISTINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:MAWN
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 1:927 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3024
Mailing Address - Country:US
Mailing Address - Phone:814-591-9136
Mailing Address - Fax:
Practice Address - Street 1:20 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3842
Practice Address - Country:US
Practice Address - Phone:814-375-5005
Practice Address - Fax:814-375-5007
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414698L183500000X
PARP044107L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP044107LOtherSTATE BOARD OF PHARMACY
PARP044107LOtherSTATE LISENCE