Active NPI
Keith Freal Van Heise, PHARM D
- Pharmacist
- Avondale, AZ
National Provider Identifier
1508995994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13731
- Practice address
- 12906 W Wilshire Dr
Avondale, AZ 85323-7134 - Phone
- (602) 740-6984
- NPI assigned
- Mar 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13731 | AZ | Primary |
Addresses
Primary practice location
12906 W Wilshire Dr
Avondale, AZ 85323-7134
Mailing address
12906 W Wilshire Dr
Avondale, AZ 85323-7134
Phone (602) 740-6984
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13731 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glenview Professional Pharmacy Inc | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Glenview Professional Pharmacy II
- Long Term Care Pharmacy
- Richland Hills, TX
- NPI 1841279932
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508995994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12906 W WILSHIRE DR",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853237134",
"telephone_number": "602-740-6984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12906 W WILSHIRE DR",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853237134",
"telephone_number": "602-740-6984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN HEISE",
"first_name": "KEITH",
"middle_name": "FREAL",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "13731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avondale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.