Provider Demographics
NPI:1013527464
Name:HEENAN, RANDY LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:HEENAN
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 1:2401 N ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2708
Mailing Address - Country:US
Mailing Address - Phone:402-731-4333
Mailing Address - Fax:
Practice Address - Street 1:2401 N ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2708
Practice Address - Country:US
Practice Address - Phone:402-731-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist