Provider Demographics
NPI:1619254810
Name:WEST, HEATHER R (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:R
Last Name:WEST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11025 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3109
Mailing Address - Country:US
Mailing Address - Phone:317-622-5010
Mailing Address - Fax:317-622-5014
Practice Address - Street 1:11025 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3109
Practice Address - Country:US
Practice Address - Phone:317-622-5010
Practice Address - Fax:317-622-5014
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020586A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist