Provider Demographics
NPI:1326414228
Name:HIEMSTRA, KIRSTEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:HIEMSTRA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:40663 N GANTZEL RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7008
Mailing Address - Country:US
Mailing Address - Phone:480-214-1680
Mailing Address - Fax:
Practice Address - Street 1:40663 N GANTZEL RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7008
Practice Address - Country:US
Practice Address - Phone:480-214-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist