Provider Demographics
NPI:1598059487
Name:KLEIBER, JENNIFER ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:KLEIBER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4135 WILDER RD
Mailing Address - Street 2:T-0631
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2240
Mailing Address - Country:US
Mailing Address - Phone:989-686-5143
Mailing Address - Fax:989-686-5143
Practice Address - Street 1:4135 WILDER RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2240
Practice Address - Country:US
Practice Address - Phone:989-686-5143
Practice Address - Fax:989-686-5143
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist