Provider Demographics
NPI:1144204041
Name:HEAVNER, LINDA MARIE (PHARMARGY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:HEAVNER
Suffix:
Gender:F
Credentials:PHARMARGY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12402 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2617
Mailing Address - Country:US
Mailing Address - Phone:206-244-6219
Mailing Address - Fax:
Practice Address - Street 1:12402 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-2617
Practice Address - Country:US
Practice Address - Phone:206-244-6219
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00044252247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other