Provider Demographics
NPI:1558817718
Name:KUYKENDALL, JIMMY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 MARFELL CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6528
Mailing Address - Country:US
Mailing Address - Phone:303-709-3685
Mailing Address - Fax:
Practice Address - Street 1:1375 BOULDER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2344
Practice Address - Country:US
Practice Address - Phone:303-673-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0017814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist