Provider Demographics
NPI:1346527389
Name:KLOSTERMAN, ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:KLOSTERMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 CERRILLOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTE FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-471-7874
Mailing Address - Fax:505-471-2172
Practice Address - Street 1:2308 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTE FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-471-7874
Practice Address - Fax:505-471-2172
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist