Healthcare Provider Details

I. General information

NPI: 1073959896
Provider Name (Legal Business Name): KYLE E HEIMER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 CONSTITUTION AVE
COLORADO SPRINGS CO
80915-1220
US

IV. Provider business mailing address

6930 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-1127
US

V. Phone/Fax

Practice location:
  • Phone: 719-591-9929
  • Fax: 719-591-5829
Mailing address:
  • Phone: 719-598-5191
  • Fax: 719-593-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14142
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: