MEDICARE: KEITH STARKS GUNN PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	21288	CO

General Provider Information

NPI Number	:	1447704564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH STARKS GUNN PHARM D

Provider Business Mailing Address
First Line	:	1212 RAINTREE DR UNIT C62
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1892
Country	:	US
Telephone Number	:	605-216-7884
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1721
Country	:	US
Telephone Number	:	970-484-1410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	05/09/2026

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