Provider Demographics
NPI:1063854412
Name:MUTO, HEATHER MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:MUTO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:DEWEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:402 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2104
Mailing Address - Country:US
Mailing Address - Phone:585-610-9790
Mailing Address - Fax:
Practice Address - Street 1:402 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2104
Practice Address - Country:US
Practice Address - Phone:607-271-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist