Provider Demographics
NPI:1235282567
Name:HEATH, AUDREY ANDERSON (RPH)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANDERSON
Last Name:HEATH
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 1:582 NC HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-8032
Mailing Address - Country:US
Mailing Address - Phone:919-965-8502
Mailing Address - Fax:919-965-8502
Practice Address - Street 1:110 W. SECOND ST.
Practice Address - Street 2:
Practice Address - City:KENLY
Practice Address - State:NC
Practice Address - Zip Code:27542
Practice Address - Country:US
Practice Address - Phone:919-284-2010
Practice Address - Fax:919-284-2231
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist