Provider Demographics
NPI:1194302513
Name:VANHEUKELOM, ERIC (RPH)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:VANHEUKELOM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 44TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2302
Mailing Address - Country:US
Mailing Address - Phone:515-556-8636
Mailing Address - Fax:
Practice Address - Street 1:5802 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-6132
Practice Address - Country:US
Practice Address - Phone:515-274-4609
Practice Address - Fax:515-279-4960
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist