Provider Demographics
NPI:1548673593
Name:MIALKI, HEATHER
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:MIALKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2021
Mailing Address - Country:US
Mailing Address - Phone:410-360-1509
Mailing Address - Fax:410-360-4209
Practice Address - Street 1:3400 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2021
Practice Address - Country:US
Practice Address - Phone:410-360-1509
Practice Address - Fax:410-360-4209
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist