Provider Demographics
NPI:1437540366
Name:HEATON, JESSIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:HEATON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 20TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1222
Mailing Address - Country:US
Mailing Address - Phone:806-791-4663
Mailing Address - Fax:800-791-7851
Practice Address - Street 1:3706 20TH ST STE A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1222
Practice Address - Country:US
Practice Address - Phone:806-791-4663
Practice Address - Fax:800-791-7851
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist