1932693926 NPI number — DR. HEATHER LYNNE FUTRELL PHARMD

Table of content: DR. HEATHER LYNNE FUTRELL PHARMD (NPI 1932693926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932693926 NPI number — DR. HEATHER LYNNE FUTRELL PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUTRELL
Provider First Name:
HEATHER
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932693926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 APRIL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STELLA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28582-9661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-545-6224
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1309 NC HIGHWAY 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNEADS FERRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28460-9144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-327-2052
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  27773 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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