Provider Demographics
NPI:1205116753
Name:HEISER, REX (RPH)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:
Last Name:HEISER
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 1:6840 LAKE MICHIGAN DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8064
Mailing Address - Country:US
Mailing Address - Phone:616-895-2200
Mailing Address - Fax:616-895-2201
Practice Address - Street 1:6840 LAKE MICHIGAN DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8064
Practice Address - Country:US
Practice Address - Phone:616-895-2200
Practice Address - Fax:616-895-2201
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist