Basic Information
Provider Information | |||||||||
NPI: | 1801179437 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MARKEL | ||||||||
FirstName: | HEATHER | ||||||||
MiddleName: | ALYSE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARMD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | REINHARD | ||||||||
OtherFirstName: | HEATHER | ||||||||
OtherMiddleName: | ALYSE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHARMD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 787 | ||||||||
Address2: | 103 MEDICINE WAY RD. | ||||||||
City: | PERIDOT | ||||||||
State: | AZ | ||||||||
PostalCode: | 855420787 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9284751303 | ||||||||
FaxNumber: | 9284757376 | ||||||||
Practice Location | |||||||||
Address1: | 103 MEDICINE WAY RD. | ||||||||
Address2: |   | ||||||||
City: | PERIDOT | ||||||||
State: | AZ | ||||||||
PostalCode: | 855420787 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9284751303 | ||||||||
FaxNumber: | 9284757376 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2011 | ||||||||
LastUpdateDate: | 08/17/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 17252 | NV | Y |   | Pharmacy Service Providers | Pharmacist |   | 183500000X | 03127518 | OH | N |   | Pharmacy Service Providers | Pharmacist |   |
No ID Information.