Provider Demographics
NPI:1639278302
Name:KLOCKE, THOMAS J (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:KLOCKE
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 1:2333 RAEBURN TER
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1231
Mailing Address - Country:US
Mailing Address - Phone:513-681-8351
Mailing Address - Fax:
Practice Address - Street 1:2333 RAEBURN TER
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1231
Practice Address - Country:US
Practice Address - Phone:513-681-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-11776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist