Provider Demographics
NPI:1467210153
Name:KLOCK, MAKAYLA LYNNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:LYNNE
Last Name:KLOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-1828
Mailing Address - Country:US
Mailing Address - Phone:814-288-7858
Mailing Address - Fax:
Practice Address - Street 1:817 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-1828
Practice Address - Country:US
Practice Address - Phone:814-288-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist