Provider Demographics
NPI:1033735337
Name:HANISCH, HEIDI JOY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:JOY
Last Name:HANISCH
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 1:1592 A AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:IA
Mailing Address - Zip Code:51638-6019
Mailing Address - Country:US
Mailing Address - Phone:712-215-1095
Mailing Address - Fax:
Practice Address - Street 1:705 S FREMONT ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-2101
Practice Address - Country:US
Practice Address - Phone:712-246-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028043183500000X
IA20975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist