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NPI Code Detail

MEDICARE: HEATH TIEBEN PHARM. D.

MEDICARE: HEATH TIEBEN PHARM. D.
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
1183500000XPharmacist1-17032KS

General Provider Information

NPI Number : 1932653672
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATH TIEBEN PHARM. D.
Provider Business Mailing Address
First Line : 1905 N 14TH AVE
Second Line :
City : DODGE CITY
State : KS
Zip : 67801-2304
Country : US
Telephone Number : 620-225-0872
Fax Number : 620-225-0717
Provider Business Practice Location Address
First Line : 1905 N 14TH AVE
Second Line :
City : DODGE CITY
State : KS
Zip : 67801-2304
Country : US
Telephone Number : 620-225-0872
Fax Number : 620-225-0717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2016
Last Update Date : 08/11/2016

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Directions to “ HEATH TIEBEN PHARM. D.” Practice Location

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