Provider Demographics
NPI:1437362589
Name:HEATON, DONALD A
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:A
Last Name:HEATON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 677
Mailing Address - Street 2:123 B FORBES LOOP RD
Mailing Address - City:GRANDY
Mailing Address - State:NC
Mailing Address - Zip Code:27939
Mailing Address - Country:US
Mailing Address - Phone:252-453-8500
Mailing Address - Fax:252-453-3051
Practice Address - Street 1:123 B FORBES LOOP RD
Practice Address - Street 2:
Practice Address - City:GRANDY
Practice Address - State:NC
Practice Address - Zip Code:27939
Practice Address - Country:US
Practice Address - Phone:252-453-8500
Practice Address - Fax:252-453-3051
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist