Healthcare Provider Details

I. General information

NPI: 1003904426
Provider Name (Legal Business Name): ANDREW E KIRKLYS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 E SHEA BLVD M/C 109
SCOTTSDALE AZ
85260-6719
US

IV. Provider business mailing address

14434 N PRICKLY PEAR CT
FOUNTAIN HILLS AZ
85268-3165
US

V. Phone/Fax

Practice location:
  • Phone: 480-627-0782
  • Fax: 480-661-4674
Mailing address:
  • Phone: 480-837-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12650
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47436
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30231
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: