Provider Demographics
NPI:1003232224
Name:HEENAN, TIMOTHY (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HEENAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 BROOK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3272
Mailing Address - Country:US
Mailing Address - Phone:513-470-0718
Mailing Address - Fax:
Practice Address - Street 1:8850 BROOK KNOLL DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3272
Practice Address - Country:US
Practice Address - Phone:513-470-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03111138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist