MEDICARE: BRENAN REEVES HEAPS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03225367-2	OH

General Provider Information

NPI Number	:	1164708541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENAN REEVES HEAPS RPH

Provider Business Mailing Address
First Line	:	3509 EMBASSY PKWY
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-8358
Country	:	US
Telephone Number	:	330-665-9145
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 EMBASSY PKWY
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-8358
Country	:	US
Telephone Number	:	330-665-9145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	10/28/2011

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