Healthcare Provider Details

I. General information

NPI: 1053950626
Provider Name (Legal Business Name): BRIAN HEANEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 11/27/2023
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7909 HIGHWAY N
DARDENNE PRAIRIE MO
63368-7382
US

IV. Provider business mailing address

15 BIG COUNTRY CIR
DARDENNE PRAIRIE MO
63368-8080
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-8450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberMO004726
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: