Provider Demographics
NPI:1396973004
Name:KIRKS PHARMACY AT HARTLAND, INC.
Entity type:Organization
Organization Name:KIRKS PHARMACY AT HARTLAND, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-832-3121
Mailing Address - Street 1:618 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5999
Mailing Address - Country:US
Mailing Address - Phone:253-848-2011
Mailing Address - Fax:253-848-3119
Practice Address - Street 1:618 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5999
Practice Address - Country:US
Practice Address - Phone:253-848-2011
Practice Address - Fax:253-848-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1835P0018X, 3336C0003X, 3336C0004X, 3336L0003X, 333600000X, 3336S0011X
WAPHARCF607987643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Multi-Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2001664Medicaid
2121348OtherPK