Provider Demographics
NPI:1881466159
Name:HEIM, KEITH ALLEN JR (PHARMD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLEN
Last Name:HEIM
Suffix:JR
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 1:87 CAMDEN LN
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-2751
Mailing Address - Country:US
Mailing Address - Phone:570-898-5832
Mailing Address - Fax:
Practice Address - Street 1:87 CAMDEN LN
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-2751
Practice Address - Country:US
Practice Address - Phone:570-898-5832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist