Provider Demographics
NPI:1205047750
Name:HETHCOX, DEBORAH H (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:H
Last Name:HETHCOX
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 1:1656 OLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-2534
Mailing Address - Country:US
Mailing Address - Phone:334-365-2669
Mailing Address - Fax:
Practice Address - Street 1:103 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3621
Practice Address - Country:US
Practice Address - Phone:334-358-5353
Practice Address - Fax:334-358-5352
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist