Provider Demographics
NPI:1659972271
Name:BALSAM, HEATHER COWAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:COWAN
Last Name:BALSAM
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 1:210 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1304
Mailing Address - Country:US
Mailing Address - Phone:404-643-8478
Mailing Address - Fax:
Practice Address - Street 1:135 WILLOW LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6574
Practice Address - Country:US
Practice Address - Phone:678-432-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist