Provider Demographics
NPI:1669806105
Name:HEIDE, KATIE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:HEIDE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 24TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3584
Mailing Address - Country:US
Mailing Address - Phone:701-839-9399
Mailing Address - Fax:
Practice Address - Street 1:412 24TH ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3584
Practice Address - Country:US
Practice Address - Phone:701-839-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist