Provider Demographics
NPI:1144536491
Name:HEFFELFINGER, DEREK TODD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:TODD
Last Name:HEFFELFINGER
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 1:646 LIME ST
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-9771
Mailing Address - Country:US
Mailing Address - Phone:484-695-3922
Mailing Address - Fax:
Practice Address - Street 1:2017 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-5505
Practice Address - Country:US
Practice Address - Phone:215-467-0850
Practice Address - Fax:215-339-9807
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist