Provider Demographics
NPI:1790801876
Name:PEPPLE, HEATHER J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:J
Last Name:PEPPLE
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 1:801 SEAMIST PT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1373
Mailing Address - Country:US
Mailing Address - Phone:231-580-1528
Mailing Address - Fax:
Practice Address - Street 1:934 W 7TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2013
Practice Address - Country:US
Practice Address - Phone:260-925-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist