Provider Demographics
NPI:1265713770
Name:CASSIDY, HEATHER MAE (RPH)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MAE
Last Name:CASSIDY
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 1:277 CONANT RD
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-3324
Mailing Address - Country:US
Mailing Address - Phone:207-473-9366
Mailing Address - Fax:
Practice Address - Street 1:355 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1143
Practice Address - Country:US
Practice Address - Phone:207-472-1191
Practice Address - Fax:207-472-0223
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist