Provider Demographics
NPI:1477157311
Name:HEIM, KENNETH RICHARD
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RICHARD
Last Name:HEIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-3895
Mailing Address - Country:US
Mailing Address - Phone:717-261-1556
Mailing Address - Fax:717-263-6808
Practice Address - Street 1:993 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3895
Practice Address - Country:US
Practice Address - Phone:717-261-1556
Practice Address - Fax:717-263-6808
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035338L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist