Provider Demographics
NPI:1629345715
Name:BIBEAU, HEATHER LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEIGH
Last Name:BIBEAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:LEIGH
Other - Last Name:LORENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:258 PINE TREE DRIVE
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628-0258
Mailing Address - Country:US
Mailing Address - Phone:218-743-4444
Mailing Address - Fax:218-743-4232
Practice Address - Street 1:258 PINE TREE DRIVE
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628-0258
Practice Address - Country:US
Practice Address - Phone:218-743-4444
Practice Address - Fax:218-743-4232
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist