Provider Demographics
NPI:1437212354
Name:HELTON, IVY KATHERINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IVY
Middle Name:KATHERINE
Last Name:HELTON
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 1:150 W OLD MILL WAY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-6360
Mailing Address - Country:US
Mailing Address - Phone:850-225-5104
Mailing Address - Fax:
Practice Address - Street 1:150 W OLD MILL WAY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6360
Practice Address - Country:US
Practice Address - Phone:850-225-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist