Provider Demographics
NPI:1669892782
Name:HELMES, HEATHER POWELL
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:POWELL
Last Name:HELMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEANNE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:886 RUSSIA RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13431-2607
Mailing Address - Country:US
Mailing Address - Phone:315-826-5315
Mailing Address - Fax:
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-624-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046936-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist