Provider Demographics
NPI:1003199670
Name:HEINRICHS, PHILLIP ANTHONY (PHARM D)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:HEINRICHS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 WALLINS CORNERS RD
Mailing Address - Street 2:APT 14
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1816
Mailing Address - Country:US
Mailing Address - Phone:518-627-4038
Mailing Address - Fax:
Practice Address - Street 1:4999 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7521
Practice Address - Country:US
Practice Address - Phone:518-843-6661
Practice Address - Fax:518-843-6667
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist