Provider Demographics
NPI:1285960567
Name:KIRKEGAARD, GARY JOHN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:KIRKEGAARD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4849
Mailing Address - Country:US
Mailing Address - Phone:919-661-7344
Mailing Address - Fax:919-661-7434
Practice Address - Street 1:825 TIMBER DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4849
Practice Address - Country:US
Practice Address - Phone:919-661-7344
Practice Address - Fax:919-661-7434
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920056Medicaid