Provider Demographics
NPI:1073708335
Name:GUNTHERBERG, HEATHER DAWN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DAWN
Last Name:GUNTHERBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 576 JEFFERSON AVE
Mailing Address - Street 2:MCDONALD ARMY HEALTH CLINIC
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604
Mailing Address - Country:US
Mailing Address - Phone:757-314-7612
Mailing Address - Fax:757-314-7792
Practice Address - Street 1:MCDONALD ARMY HEALTH CLINIC
Practice Address - Street 2:BLDG 576 JEFFERSON AVE
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:23604
Practice Address - Country:US
Practice Address - Phone:757-314-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206230183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist