Provider Demographics
NPI:1710942586
Name:HEINE, LARRY GILBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GILBERT
Last Name:HEINE
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 1:1366 BAYPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-3908
Mailing Address - Country:US
Mailing Address - Phone:239-394-2727
Mailing Address - Fax:239-394-8841
Practice Address - Street 1:1089 N COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2563
Practice Address - Country:US
Practice Address - Phone:239-394-3111
Practice Address - Fax:239-394-8841
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0322230001Medicare ID - Type Unspecified