Provider Demographics
NPI:1558644187
Name:OKOLOTOWICZ, HEATHER ANN
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:OKOLOTOWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 AGATE WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1236
Mailing Address - Country:US
Mailing Address - Phone:217-352-1306
Mailing Address - Fax:
Practice Address - Street 1:460 W FELICITA AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6518
Practice Address - Country:US
Practice Address - Phone:760-735-6025
Practice Address - Fax:760-735-6030
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist