Provider Demographics
NPI:1255823530
Name:RICH, HEATHER DAWN (RPH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:RICH
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 1:5645 E CASSTOWN CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CASSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45312-8748
Mailing Address - Country:US
Mailing Address - Phone:937-335-0675
Mailing Address - Fax:
Practice Address - Street 1:8701 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1066
Practice Address - Country:US
Practice Address - Phone:937-558-3333
Practice Address - Fax:937-558-3331
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist