Provider Demographics
NPI:1720414378
Name:LI, HEATHER LAUREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAUREN
Last Name:LI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LAUREN
Other - Last Name:HIATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1532 CANDISH LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5613
Mailing Address - Country:US
Mailing Address - Phone:636-699-8500
Mailing Address - Fax:
Practice Address - Street 1:909 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3094
Practice Address - Country:US
Practice Address - Phone:636-441-2534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013022779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist