Provider Demographics
NPI:1760150171
Name:HA, HEATHER KRISTEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KRISTEN
Last Name:HA
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 1:51 MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6290
Mailing Address - Country:US
Mailing Address - Phone:510-962-0115
Mailing Address - Fax:
Practice Address - Street 1:51 MEADOWS CT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-6290
Practice Address - Country:US
Practice Address - Phone:510-962-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist