Provider Demographics
NPI:1568463628
Name:HEIERMAN, THEODORE D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:D
Last Name:HEIERMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 CREW CIR
Mailing Address - Street 2:APT 12
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8445
Mailing Address - Country:US
Mailing Address - Phone:321-434-1838
Mailing Address - Fax:321-434-5211
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:DEPT OF PHARMACY
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3278
Practice Address - Country:US
Practice Address - Phone:321-434-1838
Practice Address - Fax:321-434-5211
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 36609183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy