Provider Demographics
NPI:1700224912
Name:HEIM, PAUL (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HEIM
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S OAK ST APT 206
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1420
Mailing Address - Country:US
Mailing Address - Phone:218-879-6768
Mailing Address - Fax:218-879-5313
Practice Address - Street 1:707 HIGHWAY 33 S
Practice Address - Street 2:PINETREE PLAZA
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2696
Practice Address - Country:US
Practice Address - Phone:218-879-6768
Practice Address - Fax:218-879-5313
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist