Provider Demographics
NPI:1659784015
Name:KLISE, ALEXANDRA ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANNE
Last Name:KLISE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 1ST ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-2100
Mailing Address - Country:US
Mailing Address - Phone:515-643-7590
Mailing Address - Fax:515-643-7595
Practice Address - Street 1:800 E 1ST ST STE 1800
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2100
Practice Address - Country:US
Practice Address - Phone:515-643-7590
Practice Address - Fax:515-643-7595
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist