Provider Demographics
NPI:1306133996
Name:KLUBERTANZ, PAUL GEORGE (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GEORGE
Last Name:KLUBERTANZ
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 1:1406 ERIN LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-4968
Mailing Address - Country:US
Mailing Address - Phone:262-549-3052
Mailing Address - Fax:262-784-8417
Practice Address - Street 1:2401 KOSSOW RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2904
Practice Address - Country:US
Practice Address - Phone:262-784-8417
Practice Address - Fax:262-784-8417
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9974-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist