Provider Demographics
NPI:1598112419
Name:KLEIN, KATIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HENIGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:59010 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-2073
Mailing Address - Country:US
Mailing Address - Phone:586-749-0009
Mailing Address - Fax:
Practice Address - Street 1:59010 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048-2073
Practice Address - Country:US
Practice Address - Phone:586-749-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist