Provider Demographics
NPI:1912284423
Name:FOLKNER, HEATHER R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:R
Last Name:FOLKNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5582
Mailing Address - Country:US
Mailing Address - Phone:505-346-0193
Mailing Address - Fax:
Practice Address - Street 1:2150 N ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3418
Practice Address - Country:US
Practice Address - Phone:480-215-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018661183500000X
NMRP00007737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP00007737OtherNM BOARD OF PHARMACY LICENSE
AZS018661OtherPHARMACY LICENSE