Healthcare Provider Details

I. General information

NPI: 1720063373
Provider Name (Legal Business Name): RAYMOND BRYAN HEILMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BRIDGEPORT WAY W SUITE D
UNIVERSITY PLACE WA
98466-4600
US

IV. Provider business mailing address

4727 DENVER AVE S
SEATTLE WA
98134-2316
US

V. Phone/Fax

Practice location:
  • Phone: 253-460-1879
  • Fax: 253-564-1412
Mailing address:
  • Phone: 206-763-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00010740
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: