Provider Demographics
NPI:1639438690
Name:KLEE, MARY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:KLEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 COUNTY RD 64
Mailing Address - Street 2:T-2158
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14903
Mailing Address - Country:US
Mailing Address - Phone:607-796-5911
Mailing Address - Fax:
Practice Address - Street 1:930 COUNTY RD 64
Practice Address - Street 2:T-2158
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903
Practice Address - Country:US
Practice Address - Phone:607-796-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI034591-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist