Provider Demographics
NPI:1760729628
Name:BARRY, HEATHER W (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:W
Last Name:BARRY
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 1:12165 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4298
Mailing Address - Country:US
Mailing Address - Phone:770-517-1606
Mailing Address - Fax:770-517-2315
Practice Address - Street 1:12165 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4298
Practice Address - Country:US
Practice Address - Phone:770-517-1606
Practice Address - Fax:770-517-2315
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist