Healthcare Provider Details

I. General information

NPI: 1871918599
Provider Name (Legal Business Name): MICHELE HEUER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 LINCOLN AVE
SKOKIE IL
60077-3695
US

IV. Provider business mailing address

8001 LINCOLN AVE
SKOKIE IL
60077-3695
US

V. Phone/Fax

Practice location:
  • Phone: 847-779-6176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS48038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: