Basic Information
| Provider Information | |||||||||
| NPI: | 1427450097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLETCHER | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43471 STATE HIGHWAY 299 E | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER MILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960289777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303365511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 43471 STATE HIGHWAY 299 E | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER MILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960289777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303365511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2014 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 45197 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.