Provider Demographics
NPI:1588947576
Name:HEIMANN, TIFFANY (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:HEIMANN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BOHNSTEDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3817
Mailing Address - Country:US
Mailing Address - Phone:574-269-4003
Mailing Address - Fax:574-269-5482
Practice Address - Street 1:2400 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3817
Practice Address - Country:US
Practice Address - Phone:574-269-4003
Practice Address - Fax:574-269-5482
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024184A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist