Healthcare Provider Details

I. General information

NPI: 1881988863
Provider Name (Legal Business Name): DOREEN M HIETALA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7266
  • Fax: 719-526-7673
Mailing address:
  • Phone: 719-526-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3260
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3260
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0020237
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: