Provider Demographics
NPI:1205266400
Name:STANLEY, HEATHER MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MICHELLE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1375 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4984
Mailing Address - Country:US
Mailing Address - Phone:479-750-7856
Mailing Address - Fax:479-750-7077
Practice Address - Street 1:1375 MARKET SQUARE DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4984
Practice Address - Country:US
Practice Address - Phone:479-750-7856
Practice Address - Fax:479-750-7077
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist