Provider Demographics
NPI:1427395573
Name:WADDELL, HEATHER ELLISON (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELLISON
Last Name:WADDELL
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 1:8644 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8325
Mailing Address - Country:US
Mailing Address - Phone:423-296-1908
Mailing Address - Fax:423-296-1917
Practice Address - Street 1:8644 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8325
Practice Address - Country:US
Practice Address - Phone:423-296-1908
Practice Address - Fax:423-296-1917
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
TN10855183500000X
GARPH022355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist