Healthcare Provider Details

I. General information

NPI: 1770867293
Provider Name (Legal Business Name): LISA CHRISTINE HEIKEN PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA CHRISTINE CAMERON PHARM. D.

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR
BLOOMINGTON IL
61701-3534
US

IV. Provider business mailing address

1505 EASTLAND DR
BLOOMINGTON IL
61701-3534
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-0505
  • Fax:
Mailing address:
  • Phone: 309-664-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.295272
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: