Healthcare Provider Details

I. General information

NPI: 1104018076
Provider Name (Legal Business Name): DONALD GENE HEFFELMIRE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 W VALENCIA RD
TUCSON AZ
85746-8036
US

IV. Provider business mailing address

2929 W VALENCIA RD
TUCSON AZ
85746-8036
US

V. Phone/Fax

Practice location:
  • Phone: 520-578-0138
  • Fax: 520-578-0319
Mailing address:
  • Phone: 520-578-0138
  • Fax: 520-578-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.287000
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019546A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026410
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: