Provider Demographics
NPI:1740885623
Name:HEINZ, JOHN (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HEINZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 MIRANDA CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5143
Mailing Address - Country:US
Mailing Address - Phone:703-300-4150
Mailing Address - Fax:
Practice Address - Street 1:6360 HOADLY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-3422
Practice Address - Country:US
Practice Address - Phone:703-897-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist