Provider Demographics
NPI:1710167614
Name:KLOSS, STEPHEN ALAN (RP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ALAN
Last Name:KLOSS
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2333
Mailing Address - Country:US
Mailing Address - Phone:609-387-1693
Mailing Address - Fax:
Practice Address - Street 1:87 HANOVER ST
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1131
Practice Address - Country:US
Practice Address - Phone:609-894-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01502400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist