Provider Demographics
NPI:1023304227
Name:PROFFITT, HEATHER L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:PROFFITT
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 1:1125 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2371
Mailing Address - Country:US
Mailing Address - Phone:812-284-5139
Mailing Address - Fax:812-284-5139
Practice Address - Street 1:1125 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2371
Practice Address - Country:US
Practice Address - Phone:812-284-5139
Practice Address - Fax:812-284-5139
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020206A183500000X
KY012277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist