Provider Demographics
NPI:1750869467
Name:HEIMAN, TYLER JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOHN
Last Name:HEIMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-6122
Mailing Address - Country:US
Mailing Address - Phone:620-872-2146
Mailing Address - Fax:620-872-7099
Practice Address - Street 1:105 E PEARL STREET
Practice Address - Street 2:
Practice Address - City:DIGHTON
Practice Address - State:KS
Practice Address - Zip Code:67839
Practice Address - Country:US
Practice Address - Phone:620-397-5778
Practice Address - Fax:620-397-2990
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-103095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist