Provider Demographics
NPI:1073959896
Name:HEIMER, KYLE E (RPH)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:E
Last Name:HEIMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1127
Mailing Address - Country:US
Mailing Address - Phone:719-598-5191
Mailing Address - Fax:719-593-8851
Practice Address - Street 1:5755 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1220
Practice Address - Country:US
Practice Address - Phone:719-591-9929
Practice Address - Fax:719-591-5829
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist