Provider Demographics
NPI:1447596168
Name:HEITLAND, SARAH JANE
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:HEITLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1135 N MESA DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3504
Mailing Address - Country:US
Mailing Address - Phone:480-898-8025
Mailing Address - Fax:
Practice Address - Street 1:1135 N MESA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3504
Practice Address - Country:US
Practice Address - Phone:480-898-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2014-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist