MEDICARE: KIRKS PHARMACY AT HARTLAND, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2121348	OTHER		PK

General Provider Information

NPI Number	:	1528896453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRKS PHARMACY AT HARTLAND, INC.

Provider Business Mailing Address
First Line	:	PO BOX 99
Second Line	:
City	:	EATONVILLE
State	:	WA
Zip	:	98328-0099
Country	:	US
Telephone Number	:	360-832-3121
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 S MERIDIAN
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98371-5999
Country	:	US
Telephone Number	:	253-848-2011
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. KIRK FOSTER HEINZ
Credential	:	RPH
Telephone Number	:	360-832-3121

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	01/18/2026

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Directions to “KIRKS PHARMACY AT HARTLAND, INC. ” Practice Location

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