Provider Demographics
NPI:1568747665
Name:HEINRICH, BECKY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:ANN
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 W ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2218
Mailing Address - Country:US
Mailing Address - Phone:218-724-8825
Mailing Address - Fax:218-724-1370
Practice Address - Street 1:1352 W ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2218
Practice Address - Country:US
Practice Address - Phone:218-724-8825
Practice Address - Fax:218-724-1370
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114137183500000X
WI14340-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist