Provider Demographics
NPI:1790083327
Name:SMOAK, HEATHER CAMPBELL (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CAMPBELL
Last Name:SMOAK
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 1:104 BRIDGETON DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-8513
Mailing Address - Country:US
Mailing Address - Phone:706-255-4908
Mailing Address - Fax:
Practice Address - Street 1:804 E WINTHROPE AVE
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442-1838
Practice Address - Country:US
Practice Address - Phone:478-982-5832
Practice Address - Fax:478-982-5895
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist