Provider Demographics
NPI:1033240767
Name:HEINEKE, NEIL PAUL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:PAUL
Last Name:HEINEKE
Suffix:
Gender:M
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 1:568 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MINONK
Mailing Address - State:IL
Mailing Address - Zip Code:61760-1271
Mailing Address - Country:US
Mailing Address - Phone:309-432-3451
Mailing Address - Fax:309-432-2575
Practice Address - Street 1:568 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MINONK
Practice Address - State:IL
Practice Address - Zip Code:61760-1271
Practice Address - Country:US
Practice Address - Phone:309-432-3451
Practice Address - Fax:309-432-2575
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist