Provider Demographics
NPI:1669704771
Name:HELLER, GEORGE KENNETH (PHARM D)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:KENNETH
Last Name:HELLER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:KENNY
Other - Middle Name:
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1451 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1515
Mailing Address - Country:US
Mailing Address - Phone:623-925-0280
Mailing Address - Fax:623-925-1753
Practice Address - Street 1:1451 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1515
Practice Address - Country:US
Practice Address - Phone:623-925-0280
Practice Address - Fax:623-925-1753
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist