Provider Demographics
NPI:1285787952
Name:HENKELVIG, HEATHER RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RENEE
Last Name:HENKELVIG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S WHITE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2600
Mailing Address - Country:US
Mailing Address - Phone:319-385-6745
Mailing Address - Fax:319-385-6544
Practice Address - Street 1:501 S WHITE ST STE 3
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2600
Practice Address - Country:US
Practice Address - Phone:319-385-6745
Practice Address - Fax:319-385-6544
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist