Provider Demographics
NPI:1396985164
Name:HELLER, FREDERICK R III (RPH)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:R
Last Name:HELLER
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2130
Mailing Address - Country:US
Mailing Address - Phone:631-281-8924
Mailing Address - Fax:631-395-1275
Practice Address - Street 1:999 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2130
Practice Address - Country:US
Practice Address - Phone:631-281-8924
Practice Address - Fax:631-395-1275
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist