Provider Demographics
NPI:1710256730
Name:HEINZ, JAMES DONALD X
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DONALD
Last Name:HEINZ
Suffix:X
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 SW PONDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5608
Mailing Address - Country:US
Mailing Address - Phone:785-220-9721
Mailing Address - Fax:
Practice Address - Street 1:2915 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2927
Practice Address - Country:US
Practice Address - Phone:785-271-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9192183500000X
KS1-13614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist