Provider Demographics
NPI:1396802393
Name:HELLER, KATHERINE MERRYETT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MERRYETT
Last Name:HELLER
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 1:2665 N ATLANTIC AVE
Mailing Address - Street 2:PMB 342
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-3205
Mailing Address - Country:US
Mailing Address - Phone:561-707-5266
Mailing Address - Fax:
Practice Address - Street 1:2665 N ATLANTIC AVE
Practice Address - Street 2:PMB 342
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-3205
Practice Address - Country:US
Practice Address - Phone:561-707-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40961183500000X, 1835G0303X, 1835N1003X, 1835P1200X
NC16707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy