Healthcare Provider Details

I. General information

NPI: 1568747665
Provider Name (Legal Business Name): BECKY ANN HEINRICH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1352 W ARROWHEAD RD
DULUTH MN
55811-2218
US

IV. Provider business mailing address

1352 W ARROWHEAD RD
DULUTH MN
55811-2218
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-8825
  • Fax: 218-724-1370
Mailing address:
  • Phone: 218-724-8825
  • Fax: 218-724-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number114137
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14340-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: