Basic Information
| Provider Information | |||||||||
| NPI: | 1689274813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEINEN | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARM D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1071 LAKE POINTE S | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306425128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708803821 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3101 ROSWELL RD | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300627621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786954961 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH019253 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.