Provider Demographics
NPI:1184612533
Name:HEDDING, JOHN RAY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RAY
Last Name:HEDDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 WATSABAUGH DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6114
Mailing Address - Country:US
Mailing Address - Phone:307-685-2899
Mailing Address - Fax:307-685-2631
Practice Address - Street 1:407 S MEDICAL ARTS CT
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3372
Practice Address - Country:US
Practice Address - Phone:307-685-2899
Practice Address - Fax:307-685-2631
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist