Healthcare Provider Details

I. General information

NPI: 1265101539
Provider Name (Legal Business Name): NATHAN HEITZ PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 MCARTHUR ST
MANCHESTER TN
37355-4426
US

IV. Provider business mailing address

730 PANTERA DR
MURFREESBORO TN
37128-5236
US

V. Phone/Fax

Practice location:
  • Phone: 931-728-0874
  • Fax:
Mailing address:
  • Phone: 585-766-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45449
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: