Provider Demographics
NPI:1164704193
Name:KLAZYNSKI-MARTIN, BARBARA R
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:R
Last Name:KLAZYNSKI-MARTIN
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 1:13897 CORPORATE WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-1291
Mailing Address - Country:US
Mailing Address - Phone:134-739-4503
Mailing Address - Fax:314-739-4557
Practice Address - Street 1:13897 CORPORATE WOODS TRL
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-1291
Practice Address - Country:US
Practice Address - Phone:134-739-4503
Practice Address - Fax:314-739-4557
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007009999183700000X
IL049125377183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician