Provider Demographics
NPI:1558311720
Name:HEITZ, NED B (RPH)
Entity Type:Individual
Prefix:MR
First Name:NED
Middle Name:B
Last Name:HEITZ
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 1:5401 E DAKOTA AVE
Mailing Address - Street 2:UNIT #22
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1439
Mailing Address - Country:US
Mailing Address - Phone:303-388-4912
Mailing Address - Fax:
Practice Address - Street 1:1055 CLERMONT ST
Practice Address - Street 2:VAMC PHARMACY SERVICE 119
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3808
Practice Address - Country:US
Practice Address - Phone:303-399-8020
Practice Address - Fax:303-393-5161
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1751183500000X
CO9853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist