Provider Demographics
NPI:1972875011
Name:HEINER, BRET ROYDEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:ROYDEN
Last Name:HEINER
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 1:652 E PRICE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6552
Mailing Address - Country:US
Mailing Address - Phone:435-231-3594
Mailing Address - Fax:
Practice Address - Street 1:329 N SANDHILL BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4729
Practice Address - Country:US
Practice Address - Phone:702-346-1416
Practice Address - Fax:702-346-1434
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV17750OtherNEVADA PHARMACIST LISENCE