Provider Demographics
NPI:1114479896
Name:EISENBARTH, HEATH (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:HEATH
Middle Name:
Last Name:EISENBARTH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MAIN ST
Mailing Address - Street 2:BOX 353
Mailing Address - City:WESTMORELAND
Mailing Address - State:KS
Mailing Address - Zip Code:66549-9836
Mailing Address - Country:US
Mailing Address - Phone:785-457-3611
Mailing Address - Fax:785-457-3622
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:BOX 353
Practice Address - City:WESTMORELAND
Practice Address - State:KS
Practice Address - Zip Code:66549-9836
Practice Address - Country:US
Practice Address - Phone:785-457-3611
Practice Address - Fax:785-457-3622
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-100143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist