Provider Demographics
NPI:1033149471
Name:HEIM, MARY B (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:B
Last Name:HEIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 GRAYFIELD CT SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9162
Mailing Address - Country:US
Mailing Address - Phone:616-437-5449
Mailing Address - Fax:616-464-3469
Practice Address - Street 1:4012 CASCADE ROAD S.E.
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-974-9792
Practice Address - Fax:616-464-3469
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist