Provider Demographics
NPI:1326348137
Name:KANE, HEIDI LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:KANE
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 1:442 W SIMS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-1811
Mailing Address - Country:US
Mailing Address - Phone:360-385-2860
Mailing Address - Fax:360-385-0573
Practice Address - Street 1:442 W SIMS WAY
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-1811
Practice Address - Country:US
Practice Address - Phone:360-385-2860
Practice Address - Fax:360-385-0573
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist