Provider Demographics
NPI:1437870219
Name:HEIL, KATHERINE ADRIANA (RPH)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ADRIANA
Last Name:HEIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5061
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-5061
Mailing Address - Country:US
Mailing Address - Phone:443-510-1994
Mailing Address - Fax:
Practice Address - Street 1:5204 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1906
Practice Address - Country:US
Practice Address - Phone:509-735-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61334305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH61334305OtherPHARMACIST LICENSE