Provider Demographics
NPI:1144825035
Name:KLEIN, AUDREY ELLEN
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ELLEN
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 1:248 WINTER BROOK DR
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-8019
Mailing Address - Country:US
Mailing Address - Phone:202-294-6263
Mailing Address - Fax:
Practice Address - Street 1:125 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2443
Practice Address - Country:US
Practice Address - Phone:717-263-9893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033602L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist