Provider Demographics
NPI:1700991759
Name:KIRKS PHARMACY INC
Entity Type:Organization
Organization Name:KIRKS PHARMACY INC
Other - Org Name:KIRK'S PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-0099
Mailing Address - Country:US
Mailing Address - Phone:360-832-3121
Mailing Address - Fax:360-832-4520
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2110128OtherPK
WA1016980Medicaid