Provider Demographics
NPI:1023505914
Name:STATON, HEATHER (PHARMD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STATON
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:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-0791
Mailing Address - Country:US
Mailing Address - Phone:706-638-3114
Mailing Address - Fax:
Practice Address - Street 1:324 W. PATTON STREET
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728
Practice Address - Country:US
Practice Address - Phone:706-638-3114
Practice Address - Fax:706-638-7713
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist