Provider Demographics
NPI:1942313705
Name:HEINZ, KIRK FOSTER (RPH)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:FOSTER
Last Name:HEINZ
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:P.O. BOX 99
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328
Mailing Address - Country:US
Mailing Address - Phone:360-832-3121
Mailing Address - Fax:
Practice Address - Street 1:104 MASHELL AVE N
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-8936
Practice Address - Country:US
Practice Address - Phone:360-832-3121
Practice Address - Fax:360-832-4520
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000136541835P0018X, 1835P1200X, 1835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2135726Medicaid