Provider Demographics
NPI:1689274813
Name:HEINEN, ALLISON (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HEINEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 HOG MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677
Mailing Address - Country:US
Mailing Address - Phone:770-880-3821
Mailing Address - Fax:
Practice Address - Street 1:700 OGLETHORPE AVENUE SUITE C7
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7621
Practice Address - Country:US
Practice Address - Phone:706-425-9445
Practice Address - Fax:706-425-0820
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist