Provider Demographics
NPI:1891887634
Name:HEADING, BARBARA BLACKMORE (BS PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:BLACKMORE
Last Name:HEADING
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-3010
Mailing Address - Country:US
Mailing Address - Phone:228-388-8453
Mailing Address - Fax:
Practice Address - Street 1:2384 PASS RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2236
Practice Address - Country:US
Practice Address - Phone:228-388-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST07945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist