| Doctor Name: | MRS. HEIDI JOAN VASSALLO |
| NPI Number: | 1154422145 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPHT |
| License Number: | 2901-0104-0755-004 |
| Business Practice Address: | 1436 S 6th St Macclenny, FL - 320634623 |
| Business Phone Number: | 9042595824 |
| Business Fax Number: | 9042595275 |
| Mailing Address: | 19699 Quiet Woods Ln, GLEN ST MARY |
| State: | FL |
| Postal Code: | 320402545 |
| Phone Number: | 9042597090 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 183700000X |
| License Number: | 2901-0104-0755-004 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacy Technician |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |