Provider Demographics
NPI:1912093659
Name:HEIDENREICH, ANNA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:
Last Name:HEIDENREICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 SOUTHVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5031
Mailing Address - Country:US
Mailing Address - Phone:317-786-2863
Mailing Address - Fax:
Practice Address - Street 1:8820 S MERIDIAN #105
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217
Practice Address - Country:US
Practice Address - Phone:317-865-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016343A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist