Provider Demographics
NPI:1972811297
Name:PAGE, HEATHER (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PAGE
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 1:101 N WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-2522
Mailing Address - Country:US
Mailing Address - Phone:229-732-2892
Mailing Address - Fax:229-732-2915
Practice Address - Street 1:101 N WEBSTER ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-2522
Practice Address - Country:US
Practice Address - Phone:229-732-2892
Practice Address - Fax:229-732-2915
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist