Provider Demographics
NPI:1083131254
Name:SMITH, HEATHER FERNANDEZ (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:FERNANDEZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 WHITEWAY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3539
Mailing Address - Country:US
Mailing Address - Phone:813-480-9313
Mailing Address - Fax:
Practice Address - Street 1:5014 WHITEWAY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-3539
Practice Address - Country:US
Practice Address - Phone:813-480-9313
Practice Address - Fax:813-480-9313
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist