Healthcare Provider Details

I. General information

NPI: 1477891539
Provider Name (Legal Business Name): ZOOM H HEATON RPH, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CREPE MYRTLE CT
AIKEN SC
29803-7543
US

IV. Provider business mailing address

190 CREPE MYRTLE CT
AIKEN SC
29803-7543
US

V. Phone/Fax

Practice location:
  • Phone: 803-648-7800
  • Fax:
Mailing address:
  • Phone: 803-648-7800
  • Fax: 803-648-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number8016
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number8016
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: