Provider Demographics
NPI:1548861628
Name:HEEMSTRA, JANA (PHARMD)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:HEEMSTRA
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 1:201 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7016
Mailing Address - Country:US
Mailing Address - Phone:512-528-8794
Mailing Address - Fax:
Practice Address - Street 1:201 WALTON WAY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7016
Practice Address - Country:US
Practice Address - Phone:512-528-8794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist