Provider Demographics
NPI:1245512995
Name:PEDERSEN, HEATHER MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4790
Mailing Address - Country:US
Mailing Address - Phone:541-684-9352
Mailing Address - Fax:
Practice Address - Street 1:1515 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4790
Practice Address - Country:US
Practice Address - Phone:541-684-9352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64318183500000X
ORRPH-00148211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist