Provider Demographics
NPI:1265521348
Name:HEINEMANN, SHIRLEY SIU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:SIU
Last Name:HEINEMANN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 LAKEVILLE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5698
Mailing Address - Country:US
Mailing Address - Phone:707-765-3530
Mailing Address - Fax:707-765-3816
Practice Address - Street 1:3900 LAKEVILLE HIGHWAY
Practice Address - Street 2:KAISER
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5698
Practice Address - Country:US
Practice Address - Phone:707-765-3530
Practice Address - Fax:707-765-3816
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 483681835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy