Provider Demographics
NPI:1508149071
Name:WALTERS, HEATHER MICHELE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICHELE
Last Name:WALTERS
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 1:4305 MERCER UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-4117
Mailing Address - Country:US
Mailing Address - Phone:478-471-6669
Mailing Address - Fax:478-471-9164
Practice Address - Street 1:4305 MERCER UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-4117
Practice Address - Country:US
Practice Address - Phone:478-471-6669
Practice Address - Fax:478-471-9164
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist