Provider Demographics
NPI:1588947329
Name:HEFFLINGER, ROGER G (PHARMD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:G
Last Name:HEFFLINGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1435
Mailing Address - Country:US
Mailing Address - Phone:208-376-1382
Mailing Address - Fax:
Practice Address - Street 1:10500 OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1435
Practice Address - Country:US
Practice Address - Phone:208-376-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRP4645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist