Provider Demographics
NPI:1205141181
Name:FURR, HEATHER JEWELL
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEWELL
Last Name:FURR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 JILL LOOP
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1680 E KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-6615
Practice Address - Country:US
Practice Address - Phone:318-255-3223
Practice Address - Fax:318-254-0394
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist