Provider Demographics
NPI:1760870752
Name:HEINZ, CARRIE (RPH)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:HEINZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 LAND O LAKES BLVD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3201
Mailing Address - Country:US
Mailing Address - Phone:813-803-7303
Mailing Address - Fax:813-803-7305
Practice Address - Street 1:7040 LAND O LAKES BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-3201
Practice Address - Country:US
Practice Address - Phone:813-803-7303
Practice Address - Fax:813-803-7305
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 45987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 45987OtherPHARMACIST