Provider Demographics
NPI:1134815442
Name:KLEIN, KATHLEEN D
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 FAROUSSE WAY
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-9273
Mailing Address - Country:US
Mailing Address - Phone:805-423-7031
Mailing Address - Fax:
Practice Address - Street 1:1151 CRESTON RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3031
Practice Address - Country:US
Practice Address - Phone:805-239-3028
Practice Address - Fax:805-239-4924
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36355183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician