Provider Demographics
NPI:1558900282
Name:CLELLAND, HEATHER R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:R
Last Name:CLELLAND
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:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-0298
Mailing Address - Country:US
Mailing Address - Phone:910-264-8764
Mailing Address - Fax:
Practice Address - Street 1:5351 GINGERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3091
Practice Address - Country:US
Practice Address - Phone:910-789-3259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist