Healthcare Provider Details

I. General information

NPI: 1588305569
Provider Name (Legal Business Name): CHRISTIAN ERNEST HEYDORN PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9184 E VALENCIA RD
TUCSON AZ
85747-4902
US

IV. Provider business mailing address

9184 E VALENCIA RD
TUCSON AZ
85747-4902
US

V. Phone/Fax

Practice location:
  • Phone: 520-574-8328
  • Fax: 520-574-8348
Mailing address:
  • Phone: 520-574-8328
  • Fax: 520-574-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025719
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: