Provider Demographics
NPI:1316369242
Name:HEILEMANN, KARL (RPH)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:HEILEMANN
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 1:625 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-2424
Mailing Address - Country:US
Mailing Address - Phone:860-928-4199
Mailing Address - Fax:860-928-7531
Practice Address - Street 1:625 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-2424
Practice Address - Country:US
Practice Address - Phone:860-928-4199
Practice Address - Fax:860-928-7531
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist