Active NPI
Gary Edward Kirk, DPH
- Pharmacist
- Canon City, CO
National Provider Identifier
1154440477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PHA.0022602
- Practice address
- 1703 Fremont Dr
Canon City, CO 81212-2405 - Phone
- (918) 577-2101
- NPI assigned
- Mar 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PHA.0022602 | CO | Primary |
Addresses
Primary practice location
1703 Fremont Dr
Canon City, CO 81212-2405
Mailing address
1703 Fremont Dr
Canon City, CO 81212-2405
Phone (918) 577-2101
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22602 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PHA.0022602 | CO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724976000000",
"number": "1154440477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1703 FREMONT DR",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812122405",
"telephone_number": "918-577-2101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1703 FREMONT DR",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812122405",
"telephone_number": "918-577-2101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRK",
"first_name": "GARY",
"middle_name": "EDWARD",
"credential": "DPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2024-08-30",
"certification_date": "2024-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "PHA.0022602",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "22602",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canon City, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.