Healthcare Provider Details

I. General information

NPI: 1396802393
Provider Name (Legal Business Name): KATHERINE MERRYETT HELLER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 N ATLANTIC AVE PMB 342
DAYTONA BEACH FL
32118-3205
US

IV. Provider business mailing address

2665 N ATLANTIC AVE PMB 342
DAYTONA BEACH FL
32118-3205
US

V. Phone/Fax

Practice location:
  • Phone: 561-707-5266
  • Fax:
Mailing address:
  • Phone: 561-707-5266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40961
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS40961
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPS40961
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS40961
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16707
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: