Provider Demographics
NPI:1982924759
Name:HEIMBACH, BEVERLY MORGAN (R PH)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:MORGAN
Last Name:HEIMBACH
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 AIRLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2642
Mailing Address - Country:US
Mailing Address - Phone:757-488-2880
Mailing Address - Fax:757-465-7465
Practice Address - Street 1:3531 AIRLINE BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2642
Practice Address - Country:US
Practice Address - Phone:757-488-2880
Practice Address - Fax:757-465-7465
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist