Provider Demographics
NPI:1235540246
Name:KLEMENZ, JOHN (R PH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:KLEMENZ
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 MEIJER DR
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-4205
Mailing Address - Country:US
Mailing Address - Phone:847-690-1210
Mailing Address - Fax:847-690-0265
Practice Address - Street 1:1301 MEIJER DR
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4205
Practice Address - Country:US
Practice Address - Phone:847-690-1210
Practice Address - Fax:847-690-0265
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510379141835P1200X
FLPS371711835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy