Healthcare Provider Details

I. General information

NPI: 1053936294
Provider Name (Legal Business Name): HEATHER LYNN KAUFFMAN PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26233 HOOVER RD
WARREN MI
48089-1170
US

IV. Provider business mailing address

329 FLORENCE ST
CLAWSON MI
48017-1612
US

V. Phone/Fax

Practice location:
  • Phone: 586-754-1191
  • Fax:
Mailing address:
  • Phone: 248-219-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: