Provider Demographics
NPI:1083951107
Name:GASAWAY, HEATHER MICHELE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICHELE
Last Name:GASAWAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SAND LAKE RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7632
Mailing Address - Country:US
Mailing Address - Phone:407-856-2301
Mailing Address - Fax:407-856-3602
Practice Address - Street 1:1950 SAND LAKE RD BLDG 5
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7632
Practice Address - Country:US
Practice Address - Phone:407-856-2301
Practice Address - Fax:407-856-3602
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist