Provider Demographics
NPI:1982132007
Name:PELLOT, HEATHER CHANCEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CHANCEY
Last Name:PELLOT
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 1:120 LAKEWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:AL
Mailing Address - Zip Code:36340-8200
Mailing Address - Country:US
Mailing Address - Phone:334-684-6140
Mailing Address - Fax:334-684-3280
Practice Address - Street 1:1608 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:AL
Practice Address - Zip Code:36340-1237
Practice Address - Country:US
Practice Address - Phone:334-684-2277
Practice Address - Fax:334-684-3280
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14402OtherALABAMA BOARD OF PHARMACY