Healthcare Provider Details

I. General information

NPI: 1376859801
Provider Name (Legal Business Name): ANDREW KELLY HEINZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 S MERIDIAN
PUYALLUP WA
98371-5999
US

IV. Provider business mailing address

618 S MERIDIAN
PUYALLUP WA
98371-5999
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-2011
  • Fax: 253-848-3119
Mailing address:
  • Phone: 253-848-2011
  • Fax: 253-848-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60405978
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH60405978
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60405978
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH60405978
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: