1568649507 NPI number — MS. HEIDI CHRISTINE BRAINERD RPH, MS, BCPS

Table of content: MS. HEIDI CHRISTINE BRAINERD RPH, MS, BCPS (NPI 1568649507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568649507 NPI number — MS. HEIDI CHRISTINE BRAINERD RPH, MS, BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAINERD
Provider First Name:
HEIDI
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH, MS, BCPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568649507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4160 TUDOR CENTRE DRIVE, ROOM 103
Provider Second Line Business Mailing Address:
RASU PHARMACY
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-729-4174
Provider Business Mailing Address Fax Number:
907-729-8618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4160 TUDOR CENTRE DRIVE
Provider Second Line Business Practice Location Address:
ROOM 103, RASU PHARMACY
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-729-4174
Provider Business Practice Location Address Fax Number:
907-729-8618
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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