Provider Demographics
NPI:1184966137
Name:MCLEAN, KIRSTEN SUZANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:SUZANNE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 GILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-4231
Mailing Address - Country:US
Mailing Address - Phone:303-249-0088
Mailing Address - Fax:
Practice Address - Street 1:2173 GILTSHIRE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-4231
Practice Address - Country:US
Practice Address - Phone:303-249-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00008334183500000X
KS1-104994183500000X
CO19570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist