Provider Demographics
NPI:1679786156
Name:HEINS, MICHAEL JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:HEINS
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 1:327 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3128
Mailing Address - Country:US
Mailing Address - Phone:716-626-0846
Mailing Address - Fax:
Practice Address - Street 1:8750 TRANSIT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2610
Practice Address - Country:US
Practice Address - Phone:716-568-1370
Practice Address - Fax:716-568-1369
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0331201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist