Provider Demographics
NPI:1104331842
Name:EATON-ERSKINE, HEATHER RENE (PHARMD, BCGP, FASCP)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RENE
Last Name:EATON-ERSKINE
Suffix:
Gender:F
Credentials:PHARMD, BCGP, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 GLENHAM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-2859
Mailing Address - Country:US
Mailing Address - Phone:704-517-0037
Mailing Address - Fax:
Practice Address - Street 1:2545 JETPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-7339
Practice Address - Country:US
Practice Address - Phone:800-735-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN94551835G0303X
SC117551835G0303X
NC157611835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric