Provider Demographics
NPI:1396114864
Name:HEATON, LAURA SIMONE (PHARMD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SIMONE
Last Name:HEATON
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 1:27971 BONANZA DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-6322
Mailing Address - Country:US
Mailing Address - Phone:559-977-6163
Mailing Address - Fax:
Practice Address - Street 1:5870 S KIPLING PKWY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-2070
Practice Address - Country:US
Practice Address - Phone:303-973-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist