Provider Demographics
NPI:1609158427
Name:LOHSE, HEIDI STELLING (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:STELLING
Last Name:LOHSE
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 1:1112 SW FOREST HILL CV
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2003
Mailing Address - Country:US
Mailing Address - Phone:772-466-6934
Mailing Address - Fax:
Practice Address - Street 1:1112 SW FOREST HILL CV
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2003
Practice Address - Country:US
Practice Address - Phone:772-466-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS034048183500000X
GA016890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist