Healthcare Provider Details

I. General information

NPI: 1265189567
Provider Name (Legal Business Name): JOSEPH MICHAEL HEJL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 E COMMERCIAL AVE
LOWELL IN
46356-2111
US

IV. Provider business mailing address

11910 W 90TH AVE
SAINT JOHN IN
46373-9291
US

V. Phone/Fax

Practice location:
  • Phone: 219-696-6638
  • Fax:
Mailing address:
  • Phone: 219-363-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26029587A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: