Provider Demographics
NPI:1215457965
Name:HEIING, LARRY DAVID (RPH)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:DAVID
Last Name:HEIING
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 1:501 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-1723
Mailing Address - Country:US
Mailing Address - Phone:419-302-9624
Mailing Address - Fax:419-596-3909
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONTINENTAL
Practice Address - State:OH
Practice Address - Zip Code:45831-9194
Practice Address - Country:US
Practice Address - Phone:419-596-3898
Practice Address - Fax:419-596-3909
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE