Provider Demographics
NPI:1548603806
Name:KLOB, GREGORY ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:KLOB
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 1:12169 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2459
Mailing Address - Country:US
Mailing Address - Phone:303-439-0169
Mailing Address - Fax:
Practice Address - Street 1:12169 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2459
Practice Address - Country:US
Practice Address - Phone:303-439-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist