Provider Demographics
NPI:1952697278
Name:BILLETER, HEATHER (RPH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BILLETER
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 1:11525 S PARKWAY PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-316-2512
Mailing Address - Fax:801-316-2512
Practice Address - Street 1:11525 PARKWAY PLAZA DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5605
Practice Address - Country:US
Practice Address - Phone:801-316-2512
Practice Address - Fax:801-316-2512
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3773281701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist