1073708335 NPI number — MRS. HEATHER DAWN GUNTHERBERG PHARM.D.

Table of content: MRS. HEATHER DAWN GUNTHERBERG PHARM.D. (NPI 1073708335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073708335 NPI number — MRS. HEATHER DAWN GUNTHERBERG PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNTHERBERG
Provider First Name:
HEATHER
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073708335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLDG 576 JEFFERSON AVE
Provider Second Line Business Mailing Address:
MCDONALD ARMY HEALTH CLINIC
Provider Business Mailing Address City Name:
FORT EUSTIS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-314-7612
Provider Business Mailing Address Fax Number:
757-314-7792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MCDONALD ARMY HEALTH CLINIC
Provider Second Line Business Practice Location Address:
BLDG 576 JEFFERSON AVE
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
23604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-314-7612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0202206230 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P0018X , with the licence number: 0202206230 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)