Provider Demographics
NPI:1164708541
Name:HEAPS, BRENAN REEVES (RPH)
Entity Type:Individual
Prefix:
First Name:BRENAN
Middle Name:REEVES
Last Name:HEAPS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 EMBASSY PKWY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8358
Mailing Address - Country:US
Mailing Address - Phone:330-665-9145
Mailing Address - Fax:
Practice Address - Street 1:3509 EMBASSY PKWY
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8358
Practice Address - Country:US
Practice Address - Phone:330-665-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225367-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist