Provider Demographics
NPI:1376143875
Name:SHIMKUS, HEATHER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:SHIMKUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 BARTEL BLVD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-8219
Mailing Address - Country:US
Mailing Address - Phone:815-777-1301
Mailing Address - Fax:
Practice Address - Street 1:10000 BARTEL BLVD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-8219
Practice Address - Country:US
Practice Address - Phone:815-777-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist