Provider Demographics
NPI:1467747600
Name:MIZER, HEIDI E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:E
Last Name:MIZER
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 1:3201 IOWA ST
Mailing Address - Street 2:T0531
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5205
Mailing Address - Country:US
Mailing Address - Phone:785-832-0312
Mailing Address - Fax:
Practice Address - Street 1:3201 IOWA ST
Practice Address - Street 2:T0531
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046
Practice Address - Country:US
Practice Address - Phone:785-832-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist