Provider Demographics
NPI:1831437391
Name:INA, HEATHER BROOKE (RPH)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BROOKE
Last Name:INA
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 1:242 N ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5506
Mailing Address - Country:US
Mailing Address - Phone:407-599-0210
Mailing Address - Fax:407-599-0436
Practice Address - Street 1:242 N ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5506
Practice Address - Country:US
Practice Address - Phone:407-599-0210
Practice Address - Fax:407-599-0436
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist