Provider Demographics
NPI:1740934595
Name:HEISLER, MARK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:HEISLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14469 E WETHERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2101
Mailing Address - Country:US
Mailing Address - Phone:480-392-8996
Mailing Address - Fax:
Practice Address - Street 1:14469 E WETHERSFIELD RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2101
Practice Address - Country:US
Practice Address - Phone:480-392-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist