Provider Demographics
NPI:1306165238
Name:CARDONA, HEATHER MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:CARDONA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 PEARL ST
Mailing Address - Street 2:PHARMERICA
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5406
Mailing Address - Country:US
Mailing Address - Phone:508-427-5006
Mailing Address - Fax:508-584-2281
Practice Address - Street 1:1123 PEARL ST
Practice Address - Street 2:PHARMERICA
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5406
Practice Address - Country:US
Practice Address - Phone:508-427-5000
Practice Address - Fax:508-584-2281
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA23619OtherPHARMACY LICENSE NUMBER