Basic Information
| Provider Information | |||||||||
| NPI: | 1295256626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEINERT | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1529 MUD CREEK RD | ||||||||
| Address2: | |||||||||
| City: | ALTO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305102631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705308903 | ||||||||
| FaxNumber: | 7067780474 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 FURNITURE DR | ||||||||
| Address2: | |||||||||
| City: | CORNELIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067780474 | ||||||||
| FaxNumber: | 7067780474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2017 | ||||||||
| LastUpdateDate: | 07/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 014694 | GA | N | Pharmacy Service Providers | Pharmacist | 183500000X | RPH014694 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.