Provider Demographics
NPI:1689694499
Name:KLINE, BRADLEY ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALAN
Last Name:KLINE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1950
Mailing Address - Country:US
Mailing Address - Phone:515-967-4213
Mailing Address - Fax:515-967-3402
Practice Address - Street 1:120 8TH ST SE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1950
Practice Address - Country:US
Practice Address - Phone:515-967-4213
Practice Address - Fax:515-967-3402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20381OtherPHARMACIST LICENSE NUMBER