Provider Demographics
NPI:1275917767
Name:KLESSER, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KLESSER
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 1:455 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-5214
Mailing Address - Country:US
Mailing Address - Phone:717-632-4887
Mailing Address - Fax:844-411-6766
Practice Address - Street 1:455 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-5214
Practice Address - Country:US
Practice Address - Phone:717-632-4887
Practice Address - Fax:844-411-6766
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI005534183500000X
PARP042318L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist