Provider Demographics
NPI:1679177828
Name:HEATH, KATHERINE DUMAS
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DUMAS
Last Name:HEATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 OGLETREE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-7716
Mailing Address - Country:US
Mailing Address - Phone:334-502-8363
Mailing Address - Fax:
Practice Address - Street 1:1888 OGLETREE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-7716
Practice Address - Country:US
Practice Address - Phone:334-502-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist