Provider Demographics
NPI:1447545264
Name:DWYER, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:DALKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 ISLAND POND RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1029
Mailing Address - Country:US
Mailing Address - Phone:413-737-6294
Mailing Address - Fax:413-732-0554
Practice Address - Street 1:126 ISLAND POND RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1029
Practice Address - Country:US
Practice Address - Phone:413-737-6294
Practice Address - Fax:413-732-0554
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist