Provider Demographics
NPI:1649921578
Name:HEIMBERG, WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HEIMBERG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:WILL
Other - Middle Name:
Other - Last Name:HEIMBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-0281
Mailing Address - Country:US
Mailing Address - Phone:707-468-4333
Mailing Address - Fax:
Practice Address - Street 1:707 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5335
Practice Address - Country:US
Practice Address - Phone:707-468-8707
Practice Address - Fax:707-468-9707
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH362361835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care