Provider Demographics
NPI:1235510777
Name:YENNIE, HEATHER JOLINE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:JOLINE
Last Name:YENNIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:MN
Mailing Address - Zip Code:56097-1633
Mailing Address - Country:US
Mailing Address - Phone:507-553-3161
Mailing Address - Fax:507-553-3914
Practice Address - Street 1:36 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:MN
Practice Address - Zip Code:56097-1633
Practice Address - Country:US
Practice Address - Phone:507-553-3161
Practice Address - Fax:507-553-3914
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist