Provider Demographics
NPI:1255906632
Name:DEXTER, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DEXTER
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 1:3631 STRAND RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-8590
Mailing Address - Country:US
Mailing Address - Phone:231-830-6514
Mailing Address - Fax:
Practice Address - Street 1:3263 COLBY RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-8601
Practice Address - Country:US
Practice Address - Phone:231-893-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty