MEDICARE: THEODORE HEUN PHARMACIST

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	9457-40	WI

General Provider Information

NPI Number	:	1427455468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE HEUN PHARMACIST

Provider Business Mailing Address
First Line	:	6060 N IRONWOOD LN
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-4423
Country	:	US
Telephone Number	:	414-961-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 W SILVER SPRING DR
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-4400
Country	:	US
Telephone Number	:	414-247-8591
Fax Number	:	414-247-8603

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

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	11/19/2014

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