MEDICARE: MR. GREGORY EDWIN HEIKES 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	11669	KS

General Provider Information

NPI Number	:	1417365198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY EDWIN HEIKES RPH

Provider Business Mailing Address
First Line	:	245 E FISCHER LN
Second Line	:
City	:	KINGMAN
State	:	KS
Zip	:	67068-9004
Country	:	US
Telephone Number	:	620-532-5910
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 N MAIN ST
Second Line	:
City	:	KINGMAN
State	:	KS
Zip	:	67068-1334
Country	:	US
Telephone Number	:	620-532-5113
Fax Number	:

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

Provider Enumeration Date	:	07/26/2014
Last Update Date	:	07/26/2014

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