Provider Demographics
NPI:1417365198
Name:HEIKES, GREGORY EDWIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:EDWIN
Last Name:HEIKES
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 1:245 E FISCHER LN
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-9004
Mailing Address - Country:US
Mailing Address - Phone:620-532-5910
Mailing Address - Fax:
Practice Address - Street 1:211 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1334
Practice Address - Country:US
Practice Address - Phone:620-532-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist