Provider Demographics
NPI:1871884908
Name:WOLCOTT, HEATHER R (PHARMD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:WOLCOTT
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 1:16700 N MARKETPLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7909
Mailing Address - Country:US
Mailing Address - Phone:208-465-3809
Mailing Address - Fax:208-465-3806
Practice Address - Street 1:16700 N MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7909
Practice Address - Country:US
Practice Address - Phone:208-465-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2557183500000X
WAPH00052420183500000X
IL051295549183500000X
ORRPH0017329183500000X
IDP5784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist