Jacqueline Heineman, PHARM. D

Primary specialty

PharmacistTaxonomy code 183500000X

License

P6454 Issued in ID

Practice address

2003 Kootenai Healthy Way Pharmacy
Coeur D'Alene, ID 83814

Phone

(208) 765-9586

NPI assigned

Jul 20, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482969600000",
    "number": "1376898742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTHY WAY- PHARMACY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTHY WAY PHARMACY",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-765-9586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINEMAN",
        "first_name": "JACQUELINE",
        "credential": "PHARM. D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-20",
        "last_updated": "2016-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P6454",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH60191857",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MT",
            "license": "6281",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Brent Earl Hirschi, DC
• Susan Marie Holasek, LCPC
• Jeffery T. Meech, PSYD, PA
• John a Wolfe, PH.D., LLC and Associates

• Pharmacist in Coeur D'Alene, ID
• Providers in Coeur D'Alene, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.