Provider Demographics
NPI:1053936294
Name:KAUFFMAN, HEATHER LYNN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26261 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4447
Mailing Address - Country:US
Mailing Address - Phone:248-356-9732
Mailing Address - Fax:
Practice Address - Street 1:26261 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4447
Practice Address - Country:US
Practice Address - Phone:248-356-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist