Provider Demographics
NPI:1922161652
Name:ROBERTS, HEATHER S (RPH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:ROBERTS
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 1:1105 E WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-7793
Mailing Address - Country:US
Mailing Address - Phone:574-268-4287
Mailing Address - Fax:
Practice Address - Street 1:500 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4307
Practice Address - Country:US
Practice Address - Phone:574-268-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020533A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist