Provider Demographics
NPI:1861619579
Name:HEIRES, EMILY ROSE (CPHT)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:ROSE
Last Name:HEIRES
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-9124
Mailing Address - Country:US
Mailing Address - Phone:517-546-7254
Mailing Address - Fax:
Practice Address - Street 1:2020 GREEN RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2553
Practice Address - Country:US
Practice Address - Phone:734-994-7246
Practice Address - Fax:734-994-0638
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI380101061156085183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician