Provider Demographics
NPI:1528341013
Name:DELUCIA, HEATHER MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:DELUCIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:TETLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10 WOODSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3514
Mailing Address - Country:US
Mailing Address - Phone:802-773-6980
Mailing Address - Fax:802-773-8513
Practice Address - Street 1:10 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3514
Practice Address - Country:US
Practice Address - Phone:802-773-6980
Practice Address - Fax:802-773-8513
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0003685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist