Edward Heacox, RPH
Individual provider Active NPI Pharmacist · Canaan, CT
NPI 1982107199 · NPPES record last updated Mar 14, 2018
Key facts
- NPI
- 1982107199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PCT.0006283 (CT)
- Practice address
- 99 S Canaan Rd
Canaan, CT 06018-2502 - Phone
- (860) 824-3822
- NPI assigned
- Mar 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.0006283 | CT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PCT.0006283 | CT | Yes |
Addresses
Primary practice location
99 S Canaan Rd
Canaan, CT 06018-2502
Mailing address
12 Hunting RDG
Sharon, CT 06069-2463
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 022756516 | Other | CT | DRIVERS LICENSE |
Other providers in Canaan, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.