Provider Demographics
NPI:1003106063
Name:HEIMBACH, CRAIG CHARLES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:CHARLES
Last Name:HEIMBACH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 WEXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-7792
Mailing Address - Country:US
Mailing Address - Phone:810-488-5022
Mailing Address - Fax:810-724-3486
Practice Address - Street 1:557 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-1165
Practice Address - Country:US
Practice Address - Phone:810-724-0576
Practice Address - Fax:810-724-3486
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist