Provider Demographics
NPI:1760088728
Name:HEINZ, AMBER (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HEINZ
Suffix:
Gender:F
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-0026
Mailing Address - Country:US
Mailing Address - Phone:715-866-8644
Mailing Address - Fax:
Practice Address - Street 1:7438 MAIN ST W
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8206
Practice Address - Country:US
Practice Address - Phone:715-866-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20504-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36223500Medicaid