Healthcare Provider Details

I. General information

NPI: 1558644187
Provider Name (Legal Business Name): HEATHER ANN OKOLOTOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W FELICITA AVE
ESCONDIDO CA
92025-6518
US

IV. Provider business mailing address

6450 AGATE WAY
CARLSBAD CA
92011-1236
US

V. Phone/Fax

Practice location:
  • Phone: 760-735-6025
  • Fax: 760-735-6030
Mailing address:
  • Phone: 217-352-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: