Healthcare Provider Details

I. General information

NPI: 1790935351
Provider Name (Legal Business Name): JOHN PATRICK HEYDINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MANSFIELD AVE
SHELBY OH
44875-1367
US

IV. Provider business mailing address

1380 BENBRANDON CT
MANSFIELD OH
44906-3239
US

V. Phone/Fax

Practice location:
  • Phone: 419-347-1506
  • Fax:
Mailing address:
  • Phone: 419-571-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: