Healthcare Provider Details

I. General information

NPI: 1588947576
Provider Name (Legal Business Name): TIFFANY HEIMANN PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY BOHNSTEDT

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E CENTER ST
WARSAW IN
46580-3817
US

IV. Provider business mailing address

2400 E CENTER ST
WARSAW IN
46580-3817
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-4003
  • Fax: 574-269-5482
Mailing address:
  • Phone: 574-269-4003
  • Fax: 574-269-5482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26024184A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: