Provider Demographics
NPI:1942378278
Name:FERRARESE, HEATHER L (RPH, PHARM D)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:FERRARESE
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:BARTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH, PHARM D
Mailing Address - Street 1:P.O.BOX 630
Mailing Address - Street 2:10 LAFAYETTE PARK
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830
Mailing Address - Country:US
Mailing Address - Phone:607-843-2841
Mailing Address - Fax:
Practice Address - Street 1:10 LAFAYETTE PARK
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830
Practice Address - Country:US
Practice Address - Phone:607-843-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044432OtherNYS LICENSE NUMBER