Healthcare Provider Details

I. General information

NPI: 1801981709
Provider Name (Legal Business Name): SHAWNA RAE HECK R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N FOSTER ST
MITCHELL SD
57301-2966
US

IV. Provider business mailing address

2301 KELLY DR
MITCHELL SD
57301-6376
US

V. Phone/Fax

Practice location:
  • Phone: 605-995-5670
  • Fax: 605-996-6805
Mailing address:
  • Phone: 605-996-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4618
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: