Provider Demographics
NPI:1396993010
Name:HEILMAN, THOMAS TAYLOR (PHARM D)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:TAYLOR
Last Name:HEILMAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 DONELSON AVE
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-3113
Mailing Address - Country:US
Mailing Address - Phone:615-541-7374
Mailing Address - Fax:615-357-0046
Practice Address - Street 1:1100 DONELSON AVE
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-3113
Practice Address - Country:US
Practice Address - Phone:615-541-7374
Practice Address - Fax:615-357-0046
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10411OtherPHARMACY LISCENCE