Provider Demographics
NPI:1417298720
Name:POOLE, HEATHER DAVIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAVIS
Last Name:POOLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3616
Mailing Address - Country:US
Mailing Address - Phone:843-761-5255
Mailing Address - Fax:843-761-5255
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3616
Practice Address - Country:US
Practice Address - Phone:843-761-5255
Practice Address - Fax:843-761-5255
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC012143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist