Provider Demographics
NPI:1851733216
Name:WILLETT, HEATHER JOY (RPH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JOY
Last Name:WILLETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 OTTERBIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-9071
Mailing Address - Country:US
Mailing Address - Phone:330-875-8320
Mailing Address - Fax:
Practice Address - Street 1:2574 EASTON ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2662
Practice Address - Country:US
Practice Address - Phone:330-492-6203
Practice Address - Fax:330-491-1372
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist