Provider Demographics
NPI:1891810511
Name:HEIRD, PAUL EDGAR
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDGAR
Last Name:HEIRD
Suffix:
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 1:152 KAWGA WAY
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-2802
Mailing Address - Country:US
Mailing Address - Phone:865-385-4398
Mailing Address - Fax:
Practice Address - Street 1:1610 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5652
Practice Address - Country:US
Practice Address - Phone:865-380-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist