Provider Demographics
NPI:1528896453
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:FOSTER
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIRKS PHARMACY AT HARTLAND, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-23
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2001664Medicaid
2121348OtherPK