Provider Demographics
NPI:1053527663
Name:HEITERT, HEATHER DAWN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DAWN
Last Name:HEITERT
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 1:259 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1908
Mailing Address - Country:US
Mailing Address - Phone:219-331-3147
Mailing Address - Fax:
Practice Address - Street 1:750 INDIAN BOUNDARY RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-1519
Practice Address - Country:US
Practice Address - Phone:219-926-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020593A183500000X
CO16684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist