Provider Demographics
NPI:1932145588
Name:HECKMAN, DAVID MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:HECKMAN
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 1:800 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4945
Mailing Address - Country:US
Mailing Address - Phone:575-578-1220
Mailing Address - Fax:888-320-1365
Practice Address - Street 1:800 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4945
Practice Address - Country:US
Practice Address - Phone:575-578-1220
Practice Address - Fax:888-320-1365
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022788183500000X
NMRP00007199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist