Provider Demographics
NPI:1659550119
Name:KLINE, ROBERT J (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:KLINE
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 1:21 NEW YORK STATE ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13607
Mailing Address - Country:US
Mailing Address - Phone:315-482-6270
Mailing Address - Fax:
Practice Address - Street 1:21 NEW YORK STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607
Practice Address - Country:US
Practice Address - Phone:315-482-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist