Provider Demographics
NPI:1679029417
Name:MARLOW, HEATHER (CPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MARLOW
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 E BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2601
Mailing Address - Country:US
Mailing Address - Phone:937-231-4387
Mailing Address - Fax:
Practice Address - Street 1:5300 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424
Practice Address - Country:US
Practice Address - Phone:937-233-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH360101060762233183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician