Provider Demographics
NPI:1174647887
Name:KLOOS, SEAMUS NEAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEAMUS
Middle Name:NEAL
Last Name:KLOOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1619
Mailing Address - Country:US
Mailing Address - Phone:618-443-2715
Mailing Address - Fax:618-443-6218
Practice Address - Street 1:157 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1619
Practice Address - Country:US
Practice Address - Phone:618-443-2715
Practice Address - Fax:618-443-6218
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist