Provider Demographics
NPI:1376893339
Name:KLEITZ, SARAH JEAN (CPHT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:KLEITZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3016 WIMBERG AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-5934
Mailing Address - Country:US
Mailing Address - Phone:812-205-5023
Mailing Address - Fax:
Practice Address - Street 1:3016 WIMBERG AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-5934
Practice Address - Country:US
Practice Address - Phone:812-205-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67019086A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician