MEDICARE: THEODORE JOSEPH HEINZ II PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	065924	NY

General Provider Information

NPI Number	:	1598414922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE JOSEPH HEINZ II PHARMD

Provider Business Mailing Address
First Line	:	863 MONTAUK HWY
Second Line	:
City	:	SHIRLEY
State	:	NY
Zip	:	11967-2111
Country	:	US
Telephone Number	:	631-399-1352
Fax Number	:

Provider Business Practice Location Address
First Line	:	863 MONTAUK HWY
Second Line	:
City	:	SHIRLEY
State	:	NY
Zip	:	11967-2111
Country	:	US
Telephone Number	:	631-399-1352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/22/2022

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