Provider Demographics
NPI:1710263413
Name:PHIPPS, HEATHER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:PHIPPS
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 1:571 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2466
Mailing Address - Country:US
Mailing Address - Phone:810-538-0014
Mailing Address - Fax:810-538-0020
Practice Address - Street 1:571 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2466
Practice Address - Country:US
Practice Address - Phone:810-538-0014
Practice Address - Fax:810-538-0020
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist