Provider Demographics
NPI:1356606214
Name:HEINZ, BERNARD J (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:HEINZ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 CHADWICK CT
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4034
Mailing Address - Country:US
Mailing Address - Phone:952-447-1765
Mailing Address - Fax:952-447-1765
Practice Address - Street 1:7535 W BROADWAY AVE
Practice Address - Street 2:T-693
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1287
Practice Address - Country:US
Practice Address - Phone:763-425-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist