Provider Demographics
NPI:1104133453
Name:STEVENS, HEATHER ELIZABETH (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 YELLOWSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4131
Mailing Address - Country:US
Mailing Address - Phone:307-637-8361
Mailing Address - Fax:307-637-5959
Practice Address - Street 1:5800 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4131
Practice Address - Country:US
Practice Address - Phone:307-637-8361
Practice Address - Fax:307-637-5959
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist