Provider Demographics
NPI:1255924940
Name:HEINAMAN, RACHEL (CPHT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HEINAMAN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:JONESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17038-8956
Mailing Address - Country:US
Mailing Address - Phone:717-644-8489
Mailing Address - Fax:
Practice Address - Street 1:800 S 12TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6903
Practice Address - Country:US
Practice Address - Phone:717-273-8170
Practice Address - Fax:717-274-7526
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30001137183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
30001137OtherPTCB
1186817OtherNABP