Provider Demographics
NPI:1679925259
Name:DANIELS, HEATHER (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W FRONT ST APT 9
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4168
Mailing Address - Country:US
Mailing Address - Phone:406-207-2038
Mailing Address - Fax:
Practice Address - Street 1:701 SMELTER AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1940
Practice Address - Country:US
Practice Address - Phone:406-761-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-38454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist