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General NPI Number Information
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NPI Number | 1730164799
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Entity Type | Individual
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Provider Name | MARTIN HEIM III PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 164 CARROLL ST
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City | LEBANON
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State | VA
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Zip | 24266-4510
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Country | US
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Telephone | 276-889-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 111 VALLEY POINTE
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City | RICHLANDS
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State | VA
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Zip | 24641-2888
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Country | US
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Telephone | 706-566-2046
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Fax | 276-935-4279
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 0202207232
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RPH022515
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 16593
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License Number State | NV
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