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General NPI Number Information
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NPI Number | 1518277748
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Entity Type | Individual
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Provider Name | ANTOINETTE M HEBLE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 23500 US HIGHWAY 160
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City | WALSENBURG
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State | CO
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Zip | 81089-9524
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Country | US
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Telephone | 719-738-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 805 E FIELD ST BOX 683
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City | LA VETA
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State | CO
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Zip | 81055-5056
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Country | US
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Telephone | 303-594-1730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S014096
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16569
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License Number State | CO
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