Provider Demographics
NPI:1861737397
Name:CHRISTIANSEN, HEATHER (PHARM D)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 VOSS PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3660
Mailing Address - Country:US
Mailing Address - Phone:608-836-6065
Mailing Address - Fax:
Practice Address - Street 1:7422 VOSS PKWY
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3660
Practice Address - Country:US
Practice Address - Phone:608-836-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15579-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist