=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912093659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA MARIE HEIDENREICH RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8820 S MERIDIAN #105
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-865-6833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1731 SOUTHVIEW DRIVE
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46227-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-786-2863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26016343A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------