Healthcare Provider Details

I. General information

NPI: 1558817718
Provider Name (Legal Business Name): JIMMY KUYKENDALL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 BOULDER RD
LOUISVILLE CO
80027-2344
US

IV. Provider business mailing address

2065 MARFELL CT
ERIE CO
80516-6528
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-1800
  • Fax:
Mailing address:
  • Phone: 303-709-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0017814
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: