Individual
GARY EDWARD KIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
1703 FREMONT DR, CANON CITY, CO 81212-2405
(918) 577-2101
Mailing address
1703 FREMONT DR, CANON CITY, CO 81212-2405
(918) 577-2101
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHA.0022602
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22602
—
CO
Enumeration date
03/28/2007
Last updated
08/30/2024
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