Provider Demographics
NPI:1003199886
Name:PAPKE, TYRUS LOYE
Entity Type:Individual
Prefix:
First Name:TYRUS
Middle Name:LOYE
Last Name:PAPKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9043 ESTEBURY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7558
Mailing Address - Country:US
Mailing Address - Phone:719-282-0563
Mailing Address - Fax:
Practice Address - Street 1:9043 ESTEBURY CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7558
Practice Address - Country:US
Practice Address - Phone:719-282-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12150183500000X
ND4057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist