Provider Demographics
NPI:1437839776
Name:HEIN, ALEXIS SHEA
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SHEA
Last Name:HEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9008
Mailing Address - Country:US
Mailing Address - Phone:317-510-0310
Mailing Address - Fax:
Practice Address - Street 1:6939 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9008
Practice Address - Country:US
Practice Address - Phone:317-510-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030351A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist