Healthcare Provider Details

I. General information

NPI: 1053527663
Provider Name (Legal Business Name): HEATHER DAWN HEITERT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 INDIAN BOUNDARY RD
CHESTERTON IN
46304-1519
US

IV. Provider business mailing address

259 S 19TH ST
CHESTERTON IN
46304-1908
US

V. Phone/Fax

Practice location:
  • Phone: 219-926-7571
  • Fax:
Mailing address:
  • Phone: 219-331-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020593A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16684
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: