Provider Demographics
NPI:1033489950
Name:KLOSTERMANN, LARRY F (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:F
Last Name:KLOSTERMANN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 JOHN F KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-5309
Mailing Address - Country:US
Mailing Address - Phone:563-556-3705
Mailing Address - Fax:563-556-2616
Practice Address - Street 1:55 JOHN F KENNEDY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5309
Practice Address - Country:US
Practice Address - Phone:563-556-3705
Practice Address - Fax:563-556-2616
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist