Individual
DEREK T HETTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1432 E OLIVE ST, LAMAR, CO 81052-2958
(719) 336-0541
Mailing address
1432 E OLIVE ST, LAMAR, CO 81052-2958
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0022329
CO
Other
Enumeration date
04/13/2019
Last updated
04/13/2019
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