Provider Demographics
NPI:1518243781
Name:WALLER, HEATHER ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:WALLER
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 1:17239 FIVE POINTS SQ
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1699
Mailing Address - Country:US
Mailing Address - Phone:302-644-7840
Mailing Address - Fax:302-644-7844
Practice Address - Street 1:17239 FIVE POINTS SQ
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1699
Practice Address - Country:US
Practice Address - Phone:302-644-7840
Practice Address - Fax:302-644-7844
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist