Provider Demographics
NPI:1265833263
Name:HEIMANN, KENNETH (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:HEIMANN
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 1:214 U.S. HWY 41 SOUTH
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450
Mailing Address - Country:US
Mailing Address - Phone:352-726-1021
Mailing Address - Fax:352-726-0164
Practice Address - Street 1:214 U.S. HWY 41 SOUTH
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450
Practice Address - Country:US
Practice Address - Phone:352-726-1021
Practice Address - Fax:352-726-0164
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0019439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist