Healthcare Provider Details

I. General information

NPI: 1861497414
Provider Name (Legal Business Name): RENEE HEITMEYER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST STE 225
DAYTON OH
45415-1184
US

IV. Provider business mailing address

2049 GRANNY SMITH LN
MIDDLETOWN OH
45044-7999
US

V. Phone/Fax

Practice location:
  • Phone: 937-567-6172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03124481
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: