Provider Demographics
NPI:1376892059
Name:SCHULZE, HEATHER SCULLIN (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:SCULLIN
Last Name:SCHULZE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1830
Mailing Address - Country:US
Mailing Address - Phone:731-285-3999
Mailing Address - Fax:
Practice Address - Street 1:2300 LAKE RD
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1830
Practice Address - Country:US
Practice Address - Phone:731-285-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42747183500000X
LA19888183500000X
CA72760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist