Individual
MRS. HEIDI JOAN VASSALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
1436 S 6TH ST, MACCLENNY, FL 32063-4623
(904) 259-5824
(904) 259-5275
Mailing address
19699 QUIET WOODS LN, GLEN ST MARY, FL 32040-2545
(904) 259-7090
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
2901-0104-0755-004
FL
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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