Provider Demographics
NPI:1376859801
Name:HEINZ, ANDREW KELLY (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:KELLY
Last Name:HEINZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5999
Mailing Address - Country:US
Mailing Address - Phone:253-848-2011
Mailing Address - Fax:253-848-3119
Practice Address - Street 1:618 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5999
Practice Address - Country:US
Practice Address - Phone:253-848-2011
Practice Address - Fax:253-848-3119
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH604059781835P0018X, 1835P1200X, 1835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2113322Medicaid