Healthcare Provider Details

I. General information

NPI: 1447704564
Provider Name (Legal Business Name): KEITH STARKS GUNN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 S COLLEGE AVE
FORT COLLINS CO
80525-1721
US

IV. Provider business mailing address

1212 RAINTREE DR UNIT C62
FORT COLLINS CO
80526-1892
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-1410
  • Fax:
Mailing address:
  • Phone: 605-216-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number21288
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: