Provider Demographics
NPI:1720063373
Name:HEILMAN, RAYMOND BRYAN
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:BRYAN
Last Name:HEILMAN
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 1:4727 DENVER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-2316
Mailing Address - Country:US
Mailing Address - Phone:206-763-2626
Mailing Address - Fax:
Practice Address - Street 1:2700 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE D
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4600
Practice Address - Country:US
Practice Address - Phone:253-460-1879
Practice Address - Fax:253-564-1412
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist