Provider Demographics
NPI:1275138745
Name:BURKHART, HEATHER ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:BURKHART
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 1:750 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2650
Mailing Address - Country:US
Mailing Address - Phone:812-634-7379
Mailing Address - Fax:812-482-3216
Practice Address - Street 1:750 W 2ND ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2650
Practice Address - Country:US
Practice Address - Phone:812-634-7379
Practice Address - Fax:812-482-3216
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019538A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist