Provider Demographics
NPI:1114211463
Name:HEIDEMANN, KATHERINE ANN (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANN
Last Name:HEIDEMANN
Suffix:
Gender:F
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 1:14333 HWY 13 S
Mailing Address - Street 2:T1833
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2153
Mailing Address - Country:US
Mailing Address - Phone:952-226-1442
Mailing Address - Fax:
Practice Address - Street 1:14333 HWY 13 S
Practice Address - Street 2:T1833
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2153
Practice Address - Country:US
Practice Address - Phone:952-226-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist